We carried out an unannounced inspection of Victoria House on 15 January 2015. Victoria House is registered to provide accommodation with personal care for up to 15 people. The service does not provide nursing care. At the time of the inspection there were 12 people accommodated in the home. An adult social care inspector conducted the inspection.
Victoria House is an older type detached two-storey property in a residential area on the outskirts of Brierfield. There is chair lift access to both floors. Bedrooms have wash basin facilities with toilet and bathrooms located nearby. There are two comfortable lounges and a dining room. There is parking to the front of the house and on the road.
At the previous inspection on 8 January 2014 we found the service was meeting all standards assessed.
There was a registered manager in day to day charge of the home. 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 two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, relating to medicines management and infection control arrangements.
We looked at how the service managed people’s medicines. We found processes were in place for the ordering, receipt, storage, administration and disposal of medicines and medication was stored securely. However, we found improvements were needed to ensure people’s medicines were handled safely. Staff training was not recorded and there were no assessments to ensure staff were competent and safe to manage people’s medicines. There were no assessments to support one person who was administering their own medicines or to support a decision to ‘disguise’ medicines in another person’s food. Medicines for disposal were not witnessed and people had not given consent for staff to manage their medicines. You can see what action we told the provider to take at the back of the full version of the report.
The home was clean and odour free and appropriate protective clothing, such as gloves and aprons, were available. However, there were no cleaning schedules or audit systems in place to support good practice. Staff had not been provided with training in infection control and there was no designated or qualified infection control lead person for the service. We found paper towel dispensers were needed in the toilet areas and improvements were needed to the flooring and exposed pipes in the laundry. We shared our concerns with the local authority infection control lead nurse. You can see what action we told the provider to take at the back of the full version of the report.
People told us they did not have any concerns about the way they were cared for and during the inspection we did not observe anything to give us cause for concern about people’s wellbeing and safety. One person said, “I am safe here; they will look after me.” Staff had an understanding of abuse and were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice.
We found there were sufficient numbers of suitable staff to attend to people’s needs and keep them safe. We noted calls for assistance were responded to in a timely way. We found a safe and fair recruitment process had been followed and appropriate checks had been completed before staff began working for the service.
Staff were given support and received a range of induction and training to give them the necessary skills and knowledge to help them look after people properly. However, we found the training records were not up to date. People made positive comments about the staff. Comments included, “Staff are very nice” and “The staff are very friendly.”
During our visit we observed people being asked to give their consent to care and treatment by staff. However, people’s capacity to make safe decisions and choices about their lives was not always clearly recorded in the care plans; the registered manager told us she would review this.
We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere was relaxed with friendly banter between staff and people living in the home. Staff spoken with had a good knowledge of the people they supported. People said their privacy, dignity and independence were respected. One person said, “They are very nice and talk to me properly.”
People were given the support they needed at mealtimes and were offered alternatives to the menu. The meals served looked appealing and plentiful and the dining tables were appropriately and attractively set. One person said, “The meals are very good, you can have what you want. If you don’t like what is on the menu you can have something else.”
Each person who lived at the home had a care plan that was personal to them. The care plans included good information about the support people needed and arrangements were in place to monitor and respond to people’s health and well- being.
The home was warm, comfortable and clean. People were satisfied with their bedrooms and living arrangements. Improvements to the home were ongoing. However, we found the new ground floor shower room was not fitted with a suitable lock or with a privacy screen; the registered manager told us this would be discussed with the maintenance person.
People told us they had no complaints about the service and felt confident they could raise any concerns with the staff or managers. One person said, “I have no complaints. It’s a first rate place; I can’t fault anything.” We found people’s concerns were not clearly recorded which made it difficult to determine whether appropriate action had been taken, whether there were recurring problems and whether the information had been used to improve the service. The registered manager told us she would review this.
There were systems to assess and monitor the quality of the service which would help identify any improvements needed. There were opportunities for people to express their views about the service with evidence their views had been listened to and used to improve the service.