Victoria House

Victoria House is a residential care home providing personal and nursing care to up to 68 people. The service provides support to older people, some of whom are living with dementia. The service also supports younger adults who are experiencing mental health conditions in an adjacent building known as Regent House. The support provided at Regent House has the aim of enabling people to move onto living independently. Each building has its own separate facilities.

At the time of our inspection there were 45 people using the service. Not everyone who used the service received a regulated activity, such as personal or nursing care. CQC only inspects where people receive a regulated activity.

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

People’s medicines were managed safely but improvements were needed within the records for creams, patches, when required medicines and covert medicines. We have made two recommendations around this.

People were kept safe from the risk of abuse. Risks to people were appropriately assessed, monitored and managed. Staff were knowledgeable about people’s individual needs. There were enough staff to safely support people and staff were recruited safely. There were appropriate infection prevention and control procedures in place.

The service was well-led, and staff were passionate about their roles. Staff were well supported and felt valued. There were effective governance procedures in place and audits identified areas which needed improvement. Action plans were implemented and monitored until completed. Staff engaged well with professionals and made referrals where appropriate. People, relatives and staff were given opportunities to provide feedback.

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 22 October 2020).

Why we inspected

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

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.

Recommendations

We have recommended the provider consider reviewing the guidance and records kept for creams, patches and when required medicines.

We have recommended the provider consider reviewing the guidance for people who have medicines administered covertly.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Victoria House is a care home which provides residential and nursing care for up to 68 people across two adjacent buildings. Some people at the service were living with dementia and/or mental health conditions. The service had been identified by the Local Authority as a designated care setting. A designated care setting is intended for people who have tested positive for Covid-19 and are being admitted to a care home from hospital. The provider had designated 10 beds to support people to be able to be discharged from hospital.

We found the following examples of good practice.

• The service had identified a dedicated unit within the home so they could safely admit people who were positive for Covid-19. Access to and from this unit was separate from the rest of the home. A cohort of staff would work in this unit to minimise the risk of transmission.

• The designated unit looked clean and hygienic. High touch areas such as handles, and switches received additional cleaning up to four times daily.

• Environmental, coronavirus and infection control policies, procedures and audits were in place to ensure infection prevention procedures were robust.

• Staff who were planned to work on this unit were up to date with their training on infection prevention and control.

• Personal protective equipment (PPE) was worn by staff following government guidance.

• There was clear signage on the correct use of PPE and correct handwashing techniques.

• There were risk assessments to manage and minimise the risks Covid-19 presented to people who used the service, staff and visitors.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.

Victoria House is a care home which provides residential and nursing care for up to 68 people across two adjacent buildings. Some people at the service were living with dementia and/or mental health conditions. We inspected a unit with ten bedrooms allocated to be part of the designated scheme. There was no one living on this unit at the time of the inspection.

We found the following examples of practice.

• There was movement of staff between the laundry and the planned designated unit. The provider was working on a solution to prevent this.

• People isolating in the designated unit would have their own dedicated staff who provided a support bubble to support all their needs, including their meals and social support. However, this still needed to be arranged.

• National guidance was not followed on the use of personal protective equipment (PPE). Staff were not wearing PPE on the day of the inspection.

• There was a plan in place to admit people safely to the home. Work was needed to ensure people already living at the home were kept safe and away from the designated unit and make sure it was completely separated.

• There was clear signage on the correct use of PPE. Signage was still needed for handwashing techniques and not all staff had received appropriate infection control and prevention training.

• The environment was clean. Additional cleaning was planned to take place including of frequently touched surfaces.

• There were detailed risk assessments to manage and minimise the risks Covid 19 presented to people who used the service, staff and visitors.

• Staff had been consulted with about their specific risks or concerns. The registered manager was planning on revisiting the risk assessments with all staff.

We were not assured that this service currently met good infection prevention and control guidelines as a designated care setting

Victoria House accommodates older people who require residential or nursing care, some of who are living with dementia. Regent House (adjacent to the main Victoria House) supports younger adults who are experiencing mental health conditions and has the aim of enabling people to move onto living independently. Each building has its own separate facilities.

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

At the last inspection we found improvements were required with regard to the cleanliness and upkeep of the building, risk assessments and the provider’s governance of the service. At this inspection we found improvements had been made in all these areas.

People enjoyed the improved communal areas during our visit and were protected against the risks of poor maintenance through the comprehensive work overseen by the registered manager. Staff followed safe infection prevention and control procedures. People interacted warmly and in a trusting way with staff.

Risk assessments have been updated and improved and staff demonstrated good person-centred knowledge of people’s needs and the risks they faced.

People were cared for by kind, caring staff who created a warm and welcoming environment.

The registered manager had in place a range of quality assurance and auditing processes, which demonstrated ongoing improvements to the service. Staff felt supported by the registered manager, who had successfully maintained people’s safety, staff safety and a positive culture and atmosphere during a time of national pandemic.

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 requires improvement (published 3 December 2019).

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 23 October 2019. During the inspection we identified breaches of legal requirements. Following the inspection, the provider submitted an action plan to show what they would do and by when to improve person-centred care and good governance.

We completed this focused inspection to make sure they had followed their action plan and to confirm they now met legal requirements.

We undertook this focused inspection to check whether improvements had been made and sustained in these areas. This report only covers our findings in relation to the key questions safe and well-led.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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.

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.

Victoria House is a care home which provides residential and nursing care for up to 68 people across two interlinked buildings. Some people at the service were living with dementia and/or mental health conditions. At the time of the inspection 60 people were using the service.

Victoria House accommodates older people who require residential or nursing care some of who are living with dementia. Regent House (attached to Victoria House) supports younger adults who are experiencing mental health conditions and has the aim of enabling people to move onto living independently. Each building has its own separate facilities.

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

Victoria House required refurbishment and was not always free of malodours. Furnishings were worn, décor dated, and the general upkeep of the home required improving.

Risks to people’s health living in the residential wing were not consistently assessed to provide staff with guidance on how to keep people safe.

The provider’s quality assurance checks had not highlighted the issues found during this inspection regarding the standards within the service and record keeping.

Staff knew how to safeguard people from abuse. Recruitment processes were being reviewed and strengthened. Staff and people told us there was enough staff on duty to meet needs.

Most people’s care and support plans were person-centred and reflective of people’s specific health needs and future goals.

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. However, the providers procedures were not followed in practice for some people. We have made a recommendation the provider reviews their systems to strengthen this area.

The service worked closely with other professionals and agencies to best meet people’s needs. A complaints system was in place. Lessons were learnt from adverse incidents.

The provider had recently appointed a new registered manager. Staff stated they felt supported by the new registered manager, had started to receive regular supervision and annual appraisal’s were planned. Staff received training in line with the provider’s policy.

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 24 October 2018). At this inspection the service has been rated Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to how the provider maintains the premises and equipment and, monitors the quality of the service provided at this 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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Victoria House is registered to provide nursing and residential care for 68 people and the service operates across five distinct units. The home caters for people with a physical disability, people with mental health needs and people with dementia some of whom may need nursing care. At the time of the inspection 64 people were using the service.

At the last inspection on 29, 30 April and 11 May 2015 we found improvements were required to the staffing levels. The service was found to be in breach of regulations 18 (Staffing). We rated the service as ‘Requires Improvement’ in one domain and overall ‘Good’.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the service.

At this inspection we found that the registered provider had ensured sufficient skilled and experienced staff were deployed at the service.

Prior to the inspection the local authority commissioners discussed with us issues they had found at the service such as improvements needed in the general cleanliness on units; upkeep of the building, the delivery of care on the nursing unit for people living with dementia and ensuring it was clear which staff were allocated to undertake one-to-one support with people.

When we first visited the registered provider was in the process of ensuring all of the external building was cleaned and guttering was replaced where needed. A deep clean had been completed throughout the service and plans were in place to complete a refurbishment programme on the nursing unit. We completed our last days of the inspection in March 2017 in order to see the works that had been undertaken. These we found enhanced the living environment.

The registered provider had also put plans in place to refurbish other units and make needed repairs to the chapel. We saw that following the registered manager discussing with the need to repair the ceiling of the chapel and to test the stair lift engineers came out the same day to check them and determine what repairs were needed. The repairs were then scheduled for the next week. We noted that the kitchen worktops in the unit for people with physical disabilities were chipped and posed an infection control risk. The registered manager undertook to replace those immediately.

At each visit we found that the service was clean and personal, protective equipment (PPE) was available for staff.

People and relatives we spoke with told us they felt the service was safe. Risks to people using the service were assessed and plans put in place to reduce the chances of them occurring.

Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care settings. People’s medicines were managed safely. There was enough staff deployed to keep people safe.

The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed. Staff received mandatory training in a number of areas, which assisted them to support people effectively, and were supported with regular supervisions and appraisals. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were protected.

People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. The registered provider was in the process of introducing a new menu, which was designed by an external contractor and dietician. The new menu included menu choices such as poached salmon and lamb cutlets.

People and their relatives spoke positively about the staff at the service, describing them as kind and caring. Staff treated people with dignity and respect. Staff knew the people they were supporting well, and throughout our inspection we saw staff having friendly and meaningful conversations with people. People were supported to be as independent as possible and had access to advocacy services where needed. Procedures were in place to investigate and respond to complaints.

People and their relatives told us staff at the service provided personalised care. Care plans were person centred and regularly reviewed to ensure they reflected people’s current needs and preferences. We discussed with the clinical lead the need to ensure care records clearly outlined any requests people had made about the support offered such as being accompanied by staff members when they went to shops.

People were supported to access activities they enjoyed.

People and staff spoke positively about the registered manager, saying they supported them and included them in the running of the service. The registered manager and registered provider carried out a number of quality assurance checks to monitor and improve standards at the service. The registered manager had informed CQC of significant events in a timely way by submitting the required notifications. This meant we could check that appropriate action had been taken.

At this inspection we found that the provider had installed an air conditioning unit on the third floor and this assisted in reducing the temperatures to within acceptable ranges. Also the new manager was looking at the current way the space was used, as at the time of the inspection the floor was divided into two units and this decreased the flow of air.

We found that staffing levels had been increased overnight and the manager was looking at the way staff were deployed across the home during the night. She had started to look at why two separate units were operated on the third floor rather than one unit, which would have provided access to a wider range of communal areas and improved access to the available staff.

The people who lived at the home that we met found it difficult to think about recent events or at times, to have a conversation. From our observations, we found that the care staff supported people in a sensitive and empathetic manner. We found that staff were extremely committed to ensuring people received good care. We found that staff took appropriate action when people who lacked capacity may have restrictions imposed or be deprived of their liberty.

During this inspection we reviewed the training matrix and found that staff had completed all the necessary mandatory training. We saw that over the last six month staff had completed basic food hygiene, COSHH, safeguarding adults and moving and handling training. There was also sufficient staff on duty who were now up to date with basic first aid training to cover each shift.

We noted that 13 staff had received training around managing challenging behaviour and break away techniques. The acting manager also confirmed that plans were in place to ensure more staff received this training and that action was taken that ensured mandatory annual refreshers for physical intervention training were conducted.

Whilst at the home we discussed the current staffing arrangements and the acting manager provided evidence to confirm these were increased to ensure people's needs were met.

Many of the people who lived at the home found it difficult to think about recent events or at times, to have a conversation. From our observations, we found that the care staff supported people in a sensitive and empathetic manner. We found that staff were extremely committed to ensuring people received good care.

We found that the staff needed to ensure appropriate action was taken when people were deprived of their liberty. On the day of the visit, temperatures within the home were excessive: this had the potential to lead to people becoming unwell. The size of the home had led to the current numbers of staff finding it difficult to consistently support people across the 24 hours. Also staff had not received the planned mandatory training; or training around meeting the specific care needs of people; or how to deal with challenging behaviour.

Many of the people who lived at the home found it difficult to think about recent events or at times, to have a conversation. During the visit we used a specific way of observing care

to help to understand their experience of the service. From our observations, we found that the care staff supported people in a sensitive manner.

From our observations and discussions with people we found that care staff worked in ways that supported people to lead fulfilling lives and respected people's decisions. We found that staff had a good understanding of how to best meet each person's care needs. We found that the manager had successfully implemented and sustained a range of improvements and these were making sure the service met the needs of the people.