Victoria House Care Home

Victoria House Care Home provides accommodation and personal care for up to 26 older people living with a range of health care needs. Some people required support with memory loss and dementia, whilst others were reliant on care staff to assist them with their personal care and health needs.

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

The registered manager had made improvements to the governance and oversight arrangements, implementation of systems and processes to safely assess and manage risks to people, including with their medicines. The improvements made however, needed to be further developed, maintained and fully embedded into the culture of the service. For example, whilst infection control audits were being undertaken, they lacked dates of when they had been done and the dates of any action taken. Oversight of peoples’ weight was not sufficiently robust as two peoples’ weights showed significant changes in one month (up to 17 kgs weight loss in July 2019) and had not been investigated. The weights had returned to within their normal changes in the following month but again this had not been addressed to ensure peoples weights were accurate. This has now been investigated and one senior care staff member would be taking responsibility for monitoring weights supported by a new procedure to ensure consistency in how and when people were weighed.

People received care and support that was safe. One person said, “I have been here only a short time but I am safe and well looked after.” Another person said, “Very good -I am comfortable and safe, warm and fed.”

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by appropriately trained and knowledgeable staff, who had been assessed as competent.

Staff had all received training to meet people’s specific needs. During induction, they got to know people and their needs. One staff member said, “I enjoy working here, our residents are great and we all support each other.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals.

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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. One health professional said, “The staff are caring and follow instructions.” A visitor said, “Not only look after my husband but me as well.” People were relaxed, comfortable and happy in the company of staff and engaged in a positive way. People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Activities were provided and were in line with people’s preferences and interests. People were encouraged to go out and form relationships with members of the community. Staff knew people’s communication needs well and we observed them using a variety of tools, such as specific sign language, pictures and objects of reference, to gain their views.

People were involved in their care planning. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives. Visitors told us that they had discussed their loved one’s wishes and one visitor said, “I personally felt they had prepared me, not only my wife.” End of life care was delivered professionally and with compassion.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve, and had developed structures and plans to develop the service and maintain their care delivery to a good standard.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 27/10/2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made.

Why we inspected:

This was a planned inspection based on the previous rating.

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’. 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 Care Home provides accommodation and personal care for up to 26 older people living with a range of health care needs. Some people required support with memory loss and dementia, whilst others were reliant on care staff to assist them with their personal care and health needs.

Victoria House Rest Home was inspected in August 2015, where it was rated overall as inadequate. A focussed inspection took place in October 2015 to follow up on concerns in relation to safety at the home and we found the provider had not made suitable improvement and the service continued to be rated as inadequate. CQC took appropriate enforcement action and the service was placed into special measures. We inspected in May 2016 to see what improvements the provider had made to ensure they had met regulatory requirements. Considerable improvements had been made and the provider was meeting all regulations. We inspected on the 20 and 25 July 2017 was to see if the improvements had been sustained. Not all improvements seen at the May 2016 inspection had been sustained and we found breaches of regulation and we took further appropriate enforcement action. In December 2017 we undertook a focussed inspection to see if the provider had made the necessary improvements. Improvements had been made and the warning notices met within the set timescale.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service now met legal requirements. We found that whilst improvements had been made there were further improvements needed to ensure that improvements were consistent and sustained.

This is the second consecutive time the service has been rated Requires Improvement.

Whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. This included updating care plans when an identified need or directive of care changed. For example, a deterioration in mobility and nutritional needs. People’s specific personal care challenges were not always recorded clearly and responded to.

A number of audits had been developed, including those for accidents and incidents, care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and,e hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and, they were always made to feel welcome and involved in the care provided.

People spoke positively of the home and commented they felt safe. One person said, "I feel safe, staff look after us and I see my doctor when I need to." A visitor told us, “I leave after a visit knowing Mum is safe.” Our own observations and the records we looked at reflected the positive comments people made.

Most care plans reflected people’s assessed level of care needs and care delivery was person specific, holistic and based on people's preferences. Risk assessments included falls, skin damage, behaviours that distress, nutritional risks including swallowing problems and risk of choking, and moving and handling. For example, pressure relieving mattresses and cushions were in place for those who were susceptible to skin damage and pressure ulcers. The care plans also highlighted health risks such as diabetes and leg ulcers. Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people moved into the home. There were systems for the management of medicines and people received their medicines in a safe way. All staff had attended safeguarding training. They demonstrated a clear understanding of abuse; they said they would talk to the management or external bodies immediately if they had any concerns. Staff had a clear understanding of making referrals to the local authority and CQC. Pre-employment checks for staff were completed, which meant only suitable staff were working in the home. People said they felt comfortable and at ease with staff and relatives felt people were safe.

Care staff were involved in developing the care plans and all staff were expected to record the care and support provided and any changes in people's needs. The registered manager said all staff were being supported to do this and additional training was given if identified as required. People were supported to eat healthy and nutritious diets. Food and fluid charts were completed when risk of poor eating and drinking had been identified and showed people were supported to eat and drink.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service. This included the care of people with specific health needs such as diabetes and strokes. Staff had formal personal development plans, including two monthly supervisions and annual appraisals. Staff and the registered manager had a good understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. People we spoke with were very complimentary about the caring nature of staff. People told us care staff were kind and compassionate. Staff interactions demonstrated staff had built rapport with people and they responded to staff with smiles and good humour.

Activities were provided and were seen to be enjoyed by people who lived at Victoria House. Staff told us they were constantly reviewing activities and ensuring that they reflected people’s interests. Visitors came in to play bridge once a week with their friends just as they had when they had lived at home. This was really enjoyed by people. Staff had received training in end of life care and were supported by the Local Hospice team. Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns.

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 Care Home provides accommodation and personal care for up to 26 older people living with a range of health care needs. Some people required support with memory loss and dementia, whilst others were reliant on care staff to assist them with their personal care and health needs.

Victoria House Care Home was inspected in August 2015 where it was rated as inadequate overall and the CQC took enforcement action. A focussed inspection took place in October 2015 to follow up on concerns in relation to safety at the home and we found the provider had not made suitable improvement and the service continued to be rated as inadequate. CQC took further enforcement action and the service was placed into special measures. We inspected in May 2016 to see what improvements the provider had made to ensure they had met regulatory requirements. We found considerable improvements had been made and the provider was meeting all regulations. We inspected on the 20 and 25 July 2017 was to see if the improvements had been sustained. Not all improvements seen at the May 2016 inspection had been sustained. We found that the management of medicines was unsafe. People were also at risk of not receiving appropriate care and support because guidance about how people should be supported was not always in place where needed. We also found that quality monitoring systems needed further development to ensure best practice in all areas, for example, repositioning, fluids and nutrition. At this time we served Warning Notices to ensure peoples safety and well-being and further improvements to the organisational audits.

We undertook an unannounced focused inspection of Victoria House on the 28 December 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection in July 2017 had been made. The inspector inspected the service against two of the five questions we ask about services: is the service safe and well led, This is because the service was not meeting some legal requirements. This report only covers our findings in relation to the key questions of whether the service is Safe and Well-led. No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection. You can read the report from our last comprehensive inspections, by selecting the 'all reports' link for Victoria House on our website at www.cqc.org.uk.

This inspection found that improvements had been made and the breaches of regulation had been met. Whilst these improvements had been made, time was now needed to fully embed the new systems to sustain improvement. The rating over all remains 'requires improvement' as the provider needs to be able to demonstrate they can sustain into the future. This will be assessed at their next comprehensive inspection.

At this inspection there was improved managerial oversight to ensure documentation was kept up to date and ensured people received safe, effective, caring and responsive care. A range of audits had been introduced and completed either weekly (for medicines) or monthly. When audits had identified issues there was evidence of recorded actions taken to address the issues. For example, poor recording of medicines administered had led to the further training and competencies. The management and storage of medicines were safe. Care documentation and associated risk assessments had all been reviewed and a new format introduced.

Accidents and incident reporting had been completed and there was management overview of audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure learning and preventative measures had been taken.

People were encouraged to express their views and had completed surveys. They also said they felt listened to and any concerns or issues they raised were addressed. Technology was used to assist people’s care provision. People's individual needs were met by the adaptation of the premises.

Staff were asked for their opinions on the service and whether they were happy in their work. They felt supported within their roles, describing an ‘open door’ management approach, where managers were always available to discuss suggestions and address problems or concerns.

Staff had training on keeping people safe and understood the process of reporting concerns. People were protected, as far as possible, by a safe recruitment system. Staff had been checked to ensure they were suitable before starting work in the service. There were sufficient staff at this time to meet peoples’ needs. People felt comfortable with staff and said, “Great staff, caring with a sense of humour.” There was a lot of laughter and banter between people and the staff. We also saw some positive interaction between staff and the people they supported.

The provider had notified the Care Quality Commission (CQC) of all significant events which had occurred in line with their legal obligations.

The inspection took place on the 20 and 25 July 2017 and was unannounced. There were twenty people living at the home at the time of our inspection, including one person who was in hospital.

Victoria House Rest Home was inspected in August 2015. A number of breaches were identified and it was rated as inadequate and the CQC took enforcement action. A focussed inspection took place in October 2015 to follow up on concerns in relation to safety at the home and we found the provider had not made suitable improvement and the service continued to be rated as inadequate. CQC took further enforcement action and the service was placed into special measures. We inspected in May 2016 to see what improvements the provider had made to ensure they had met regulatory requirements. We found considerable improvements had been made and the provider was meeting all regulations. This inspection on the 20 and 25 July 2017 was to see if the improvements had been sustained. Not all improvements seen at the May 2016 inspection had been sustained We were informed the management structure had changed three times following the last inspection in 2016 and that there had been an increase in staff turnover.

There had been no registered manager in post since April 2017. 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. From April 2017 to July 2017 an acting manager had been in post but left the organisation a week before this inspection. At the time of the inspection there was an acting manager at Victoria House who was supported by the provider. The acting manager had been in post for a week.

Although people told us they felt safe living at the service we found the provider had not assured people’s safety in areas related to the management of medicines and had not ensured people received their prescribed medicines. Some people were at risk of not receiving appropriate care and support because guidance about how people should be supported was not always in place where needed. Accidents and incidents were not all recorded appropriately and steps had not been taken by the staff to minimise the risk of similar events happening in the future. There was a lack of management overview of accidents and incidents.

Quality monitoring systems and daily documentation completed by staff needed further development to ensure best practice in all areas, for example, repositioning, fluids and nutrition.

Staff had an understanding of the Mental Capacity Act 2005 and acted in accordance with its principles whilst supporting people. However there were areas within the documentation that was contradictory in respect of their mental capacity and decision making.

People were supported to take part in a range of activities, maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them. The provider was in the process of recruiting a new activity co-ordinator.

People’s nutritional needs were met with referrals made to dieticians and Speech and Language Therapists (SALT) when needed. People preferences and special dietary needs were met and weights were monitored regularly. People were offered a choice of food and drinks throughout the day, with alternatives available if people requested them.

Staffing levels were monitored and reviewed regularly to ensure levels were safe and appropriate to meet people’s needs. However some negative feedback in respect of night staff during the inspection had led to an urgent review of night staffing levels and as a result there had been an increase of night staff. Agency staff were used to maintain staffing quotas if needed. Newly employed staff completed an induction and all staff were provided with training, supervision and appraisals to ensure they were appropriately skilled and supported.

People were treated with dignity and were looked after by kind and compassionate staff who supported them to maintain their independence when possible.

Staff had received essential training and had a good understanding of safeguarding procedures. Staff told us what actions to take if they believed people were at risk of abuse.

A complaints procedure was readily available for people to use. People told us they would be happy to raise any concerns if they had them. Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views and satisfaction surveys had been completed.

The provider and management team had completed notifications when needed to CQC or other organisations and were aware of what needed to be notified and this was required in a timely manner.

We found a number of 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 this report.

There were seven people living at the home at the time of our inspection. Including one person who was in hospital and another who was staying at Victoria House for respite care.

Victoria House Rest Home was inspected in August 2015. A number of breaches were identified and it was rated as inadequate and the CQC took enforcement action. A focussed inspection took place in October 2015 to follow up on concerns in relation to safety at the home and we found that the provider had not made suitable improvement and the service continued to be rated as inadequate. CQC took further enforcement action and the service was placed into special measures. This inspection took place on 4 and 5 May 2016 and was a full comprehensive inspection to see what improvements the provider had made to ensure they had met regulatory requirements.

At this inspection we found that considerable improvements had been made and the provider was now meeting all regulations. However some areas required time to become fully embedded into everyday practice. This included quality monitoring systems and daily documentation completed by staff which needed further development to ensure best practice in all areas. The use of agency staff needed to be reviewed to ensure that all staff who worked at Victoria House understood their responsibilities in relation to daily documentation for people, especially daily charts in place, for example, repositioning, fluids and nutrition. Staff needed to be consistent in their recording of care provided and when completing handover forms to ensure all relevant information was recorded.

Recruitment systems needed to be tighter to ensure all relevant references and checks were available in staff files and any gaps in previous employment history were documented when discussed.

At the inspections in August and October 2015, we found that risk assessment and risk managements practices were poor. Individuals did not have the risks to their health and safety properly assessed or managed. Identified risks to the environment had not been rectified. At this inspection we found that people’s individual risks had been assessed and reviewed. Environmental risks had been addressed with a programme in place to ensure that future checks took place appropriately.

At the inspections in August and October 2015 we found that people had not been supported to ensure their nutrition and hydration needs were met. At this inspection we found people’s nutritional needs were reviewed with referrals made to Speech and Language Therapists (SALT) when needed. People preferences and special dietary needs were met and weights were monitored regularly. Fluid intake was reviewed daily and any changes reported to people’s GPs. People were offered a choice of food and drinks throughout the day, with alternatives available if people requested them.

At the inspections in August and October 2015 we found that people’s medicines were not safely managed. At this inspection we found that extensive improvements had been made to the entire medicines process. Information was in place to support staff and people received their medicines as prescribed.

At the inspections in August and October 2015 we found that accidents and incidents were not consistently documented or investigated. At this inspection we found that a new system or reporting had been implemented. This included clear information regarding the incident, who witnessed it, actions taken and a body map in place to record any injuries. Follow up checks took place and the incident discussed with staff to see if anything could be implemented to prevent the incident reoccurring.

At the inspections in August and October 2015 we found that peoples care needs had not been assessed to determine safe and appropriate staffing levels. At this inspection we found that staffing levels were monitored and reviewed regularly to ensure levels were safe and appropriate to meet people’s needs. Agency staff were used to maintain staffing quotas if needed. Newly employed staff completed an induction and all staff were provided with training, supervision and appraisals to ensure they were appropriately skilled and supported.

People were supported to take part in a range of activities, maintain their own friendships and relationships. Staff related to people as individuals and took an interest in what was important to them.

People were treated with dignity and were looked after by kind and compassionate staff who supported them to maintain their independence when possible. Staff were supported by an enthusiastic and approachable registered manager. Staff morale had improved and they told us they welcomed the positive changes.

All feedback received from people was positive about the care, the atmosphere in the service and the approach and openness of the staff and registered manager. We were told, “I love the staff you could not meet more lovely people. Beautiful people all excellent.”

Staff had received training and had a good understanding of safeguarding procedures. Staff told us what actions to take if they believed people were at risk of abuse.

The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People’s mental capacity had been assessed when needed and DoLs applications made when a need had been identified.

A complaints procedure was readily available for people to use. People told us they would be happy to raise any concerns if they had them.

Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views and satisfaction surveys had been completed. The management style was open and looked at ways of continually improving the service for people. Staff felt valued and supported by the registered manager. Telling us, “It’s a team.”

The registered manager had completed notifications when needed to CQC or other organisations and was aware of what needed to be notified and that this was required in a timely manner.

Many improvements had taken place since the last inspection and the breaches of regulations had been met. At the next inspection we will check to make sure the improvements are embedded and sustained. This is because there are currently five of a possible 26 people at the home and we will need to see that as people are admitted the improvements continue, which is why the rating is requires improvement despite no breaches having been identified.

At this inspection, we found that the improvements required to comply with the regulations in relation to cleanliness and infection control, supporting staff and ensuring that there were systems in place to assess and monitor the quality of the service had been made.

We spoke with four members of staff; these were the manager, two care workers and a domestic worker. We also took information from other sources, including meeting minutes, audit documentation and supervision notes.

The overall appearance of the service was clean and we saw that there were appropriate systems and policies in place in respect to cleanliness and infection control.

We spoke with two care workers during our inspection and were told that they felt valued and supported, and that their training needs had been met. One member of staff told us 'It's a very nice place to work'.

We also saw that the service had quality assurance systems in place to monitor the quality of the service provided, and to gain the views of the people who used the service.

Most of the people we spoke with who were living at Victoria House told us they enjoyed living at the home and were happy with the care they received.

One person told us "Staff are very good indeed and very friendly," another told us "the food is very good." A visiting relative told us "The regular staff are amazing, they work hard. There are too many agency. My relative's anxiety levels are up because there aren't enough regular staff."

Our visit was facilitated by a senior carer who was in an acting manager position and an interim manager who had been providing support on a consultancy basis for the previous two weeks. We looked at supporting care documentation and staff documentation. Fourteen people were resident at the time of our visit. We spoke with three people who used the service individually and a number of other people who were sitting in communal areas. We spoke with seven staff members and one relative. One staff member told us "I really like it here," another told us "there is a good standard of care but with so many agency staff on it can be difficult".