Victoria House Residential Home

Victoria House Residential Care Home is a residential care home providing accommodation and personal care to up to 43 people. At the time of our inspection 37 people were living at Victoria House Residential Home. The home has two floors, with bedrooms on both the ground and upper floor, with three shared communal lounges and dining rooms.

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

Systems and processes used by the provider to monitor and improve the service were in place but needed strengthening then embedding into practice. Environmental risks relating to safety checks had not been promptly carried out. Accident and incidents were monitored, however, recording of action taken required strengthening and improvement to ensure lessons were learnt.

People received medicines by staff who were suitably knowledgeable and trained. We found that medicines prescribed to thicken people’s drinks were not safely stored. When people were prescribed medicines on a 'when required basis' (PRN), guidance was available to help staff give them these medicines however they were not in line with how they had been prescribed.

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.

Staff were recruited in line with regulatory requirements to ensure only suitable staff worked

in the service.

Infection prevention and control (IPC) systems were in place. The home was visibly clean; however, we identified some IPC issues which were addressed shortly after the inspection.

Staff were confident in reporting concerns internally and to external organisations. Staff felt supported by the registered manager, who they found to be approachable and visible in the service.

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

Rating at last inspection and update

The last rating for this service was good (published 05 March 2019).

Why we inspected

We received concerns in relation to the recruitment and selection of staff. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria House Residential Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Infection prevention and control audits were completed, and infection prevention and control policies were in place.

There was a protocol in place for visitors to follow upon entry to the home, in line with government guidance.

Staff had completed several training sessions in topics related with infection and prevention control.

The registered manager conducted regular spot checks to ensure staff were following the correct procedures when donning and doffing their personal protective equipment.

There was a testing regime in place for staff and people living in the service. This was to ensure any staff or people who had contracted COVID-19 and were asymptomatic, were identified in a timely way preventing the spread of infection.

The service had established good working relationships with relevant healthcare professionals and their support continued during the pandemic.

Workforce pressures were not having a detrimental impact on the delivery of the service.

At the last inspection in October 2017 we found three key questions rated requires improvement. Since the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to be rated ‘good’. At this inspection we found improvements had been made and the service was no longer rated requires improvement.

Victoria House Residential Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide care and support for up to 41 people. At the time of our inspection 41 people were living at Victoria House Residential Home. The home has two floors, with bedrooms on both the ground and upper floor.

The service had a registered manager. 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.

The people who lived at Victoria House Residential Home told us they felt safe. There were enough staff to meet the needs of the people who currently lived there, and appropriate precautions were taken to ensure that staff had the right character to work with vulnerable people. However following employment ongoing security checks had not always been completed, we raised this with the registered manager to continue with some background checks on staff. The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding and were aware of their responsibilities to report any possible abuse.

The building was secure, clean and well maintained, and staff ensured any environmental hazards were minimised.

Care records were well kept and easy to follow. They gave a good indication of people’s abilities and provided a good description of their likes and dislikes. Where risk had been identified, risk plans were in place to minimise the risk of harm occurring. Senior staff were trained to administer medicines and we saw people were assisted to take their prescribed medicines in a way they were comfortable with by staff who understood their needs.

People were supported by a stable staff team who knew the people well. We saw that the staffing ratio reflected the needs of the people living at the service. The people we spoke with believed the staff were competent and knowledgeable. We saw from training records that all new starters received a thorough induction and ongoing refresher training to maintain their competence.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a handover meeting took place at the start and finish of every shift. This ensured that care staff were aware of any change in peoples’ needs and of any tasks which might need to be completed.

The registered manager and the care staff we spoke to, demonstrated a good understanding of capacity and consent. When people were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation.

People liked the food provided, and attention was paid to their dietary needs and preferences. Lunchtime was a sociable occasion and there was some conversation as people ate their meals.

Care staff monitored people’s general health, and where specific healthcare needs were identified the service liaised with healthcare professionals to provide an appropriate level of support.

We saw people were comfortable and well cared for. Staff were vigilant to people’s needs and could respond in a timely way to people’s requests for assistance. They respected people’s need for privacy, but understood the risk of social isolation and ensured supervision and regular checks were made when people retired to their rooms.

Regular reviews showed that people’s needs and abilities were closely monitored and any changes were noted and amended in care plans. There were some activities, and stimulation was provided at a pace suited to people’s needs. The service supported people to plan for the end of their life and considered their needs and wishes ensuring their comfort and dignity.

Staff worked well together and encouraged a culture of mutual respect. They recognised the service was people’s home and understood their role to support vulnerable people.

The registered manager was respected by staff, people who used the service and their relatives, but did not always have a visible presence throughout the home.

The service sought feedback from people and some monitoring systems were in place, but information collected by the service could be used more effectively to improve the quality of the service.

Since that inspection 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 we found that improvements have been made and action taken. The service is no longer rated as inadequate overall or in any of the key questions and is now out of Special Measures.

Victoria House Residential Home 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. The care provider, Inniscastle Care Limited, is registered to provide accommodation for up to 41 persons who require personal care only in one adapted building. At the time of our inspection there were 28 people using the service.

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 saw the service was clean and had appropriate infection control processes in place.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and they were complimentary about the level of care provided. The service had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We saw the service had systems in place for the safe administration and recording of medicines. We raised some small issues around medicines, their storage and recording. All people taking medicines had a medication administration record in place, which included a photograph to ensure medicines were given to the correct person. During the inspection most records we observed had been filled out correctly and all medicine amounts tallied.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff spoke positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were up to date. However, records showed some staff had passed the provider’s recommended refresher timescales for some courses.

Staff confirmed they received supervision with their line manager, which along with the completion of team meetings, meant they were supported in their roles. Records we saw backed up what staff had told us.

Observations of meal times showed these to be a positive experience, with people being supported to eat where they chose. Staff engaged in conversation with people and encouraged them throughout the meal. We saw nutritional assessments were in place and special dietary needs catered for.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. Both people who used the service and their relatives were complimentary about the quality of the staff and the standard of care received.

Care files contained completed pre-admission assessments and accurate and detailed information about the people who used the service and how they wished to be cared for. Each file contained detailed care plans and risk assessments, along with a range of personalised information which helped ensure their needs were being met and care they received was person centred.

Everyone we spoke to was positive about the variety and frequency of activities available. We saw the activity schedule catered for all interests and abilities and included involvement from external agencies. A large number of activities and events had been the result of suggestions made from people who used the service. The staff actively documented activities and displayed photographs of the different events that had taken place around the building.

The provider had recruited an additional member of office staff to review and complete audits and checks within the service. They had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed on a weekly and monthly basis and covered a wide range of areas including medication, care files, infection control and the overall provision of care. We saw evidence of action plans being implemented to address any issues found.

Victoria House Residential Home is a care home without nursing. The care provider, Inniscastle Care Limited, is registered to provide accommodation for up to 41 persons who require personal care.

At the time of our 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.

The registered provider did not use a tool to assess people’s dependency. We saw night staffing levels were not sufficient to meet people’s needs and the layout of the home meant staff were not always deployed in a way which met people’s needs.

Medicines were not safely managed as we saw a medication error had occurred in January 2017 when a member of staff not authorised to administer medicines was responsible for this. We saw gaps in the recording of medicine administration and found cream charts did not show people were receiving creams and lotions as prescribed. Staff medication competency checks had not been completed in the 12 months prior to our inspection for three staff members.

Risks were not appropriately managed as two upstairs windows in communal areas were found to be unrestricted. The registered provider took action to resolve this following our inspection. Weekly fire tests were last recorded as being carried out in December 2016. One person at risk of choking did not have a risk assessment for this and other risks to people had not always been identified.

Mealtimes were too close together which meant people did not have time to build an appetite for their next meal. Breakfast took place at 9:30 which was too late for some people who wanted this earlier. Biscuits were served before breakfast which meant there was no option before 9:30 for people who needed a soft diet. Food and drink was given to people without them being asked about their preferences at that time.

Care plans were not always fully completed and did not match other sections of people’s records as they had not been updated. Information which did not relate to people’s current needs was still in care plans. Monthly reviews were not always completed. Relatives had been invited to an annual review. Mental capacity was assessed as part of a pre-assessment. We saw documentation relating to consent was not always signed by the appropriate individual. Deprivation of Liberty Safeguards (DoLS) were not appropriately managed.

A programme of activities was in place, although this did not happen when the activities coordinator was absent as staff did not have time. A range of external entertainers visited the home to provide stimulation and regular trips out took place.

Confidential and sensitive information was not always securely stored as care plans were accessible to people and visitors.

Staff told us the registered manager was not approachable. The registered manager was based in a separate part of the building and managed the service remotely. Staff supervisions were not up-to-date and supervisions were based around competency questions. Training sessions were in place to address some gaps, although training in some areas which would be relevant to people’s needs was not provided.

People’s equality, diversity and human rights were not respected. Staff were in the process of arranging a religious service with a funeral provider. However, further checks during our inspection showed this person did not hold such religious beliefs.

The registered manager and deputy manager needed clearer insight into what is notifiable to the CQC. Quality management was not effective as the audits in place had not identified the concerns we found during our inspection. Notifications were not submitted to the CQC as required under the terms of the registered provider’s registration. We dealt with this outside the inspection process.

Staff meetings and ‘resident’ and relative meetings had taken place. Initial returns from a recent satisfaction survey showed people and relatives were happy with the service they received. People and relatives felt the service was well run. Complaints were appropriately managed and relatives felt this was a strength of the registered manager.

People were supported to access a range of healthcare services. Visiting healthcare professionals were complimentary about this service. Advocacy services were involved in people’s care.

People felt safe living in the home. Recruitment was managed appropriately as relevant background checks had been carried out to ensure staff were suitable to work with vulnerable people. A robust schedule of maintenance was carried out and the home was found to be clean and odour free.

People were happy with the support they received from the staff team. We saw people’s privacy and dignity was respected.

The registered provider had not ensured their rating from our last inspection was on display on their website. We dealt with this outside the inspection process.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. You can see the action we have told the provider to take at the end of this report.

The overall rating for this service is ‘Inadequate’ and the service is now 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 than 12 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.

We spoke with four people who lived in the home and one relative who was visiting. They were all very positive about their experience of Victoria House. Among their comments were:

'I can get up and go to bed when I want '

'The food is good, there is always a choice and I really like the tea time meal'

'The staff are good, they are all very approachable.'

We spoke with the manager, deputy manager, floor manager, a senior carer and a carer. All the staff we spoke with were knowledgeable about the people who lived in the home and their care needs. People's individual needs and preferences were clearly stated in their care plan and staff demonstrated that they listened to and acted on people's wishes.

People said they had no concerns during their time at Victoria House, but knew what to do if they did. All the people spoken with had positive comments about the home and how staff related to them

Throughout our visit we observed staff speaking to people about their care. On a number of occasions we saw staff explained to people what was about to happen and checked that people were in agreement with this. We observed staff asking people where they would like to sit in lounge areas. We saw staff spoke with people in a kind manner and were thoughtful and discreet when giving support to people.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people.

We spoke with four people who lived in the home and two relatives who were visiting. All the people spoken with were very positive about the care they received. One of the relatives was happy about the home and the support people receive. The other relative had some negative comments about the level of staff which they had spoken to the manager about.

We observed care staff treating people with dignity and respect. For example, they knocked on bedroom and bathroom doors before entry and when entering, discretely closed the door behind them to give people privacy.

We spoke to six people who live in the home and one relative who was visiting. All the people spoken with were complimentary about the care and support they received. One person said; 'The staff are good to you,' whilst another commented 'I like it here, we are well looked after.' People also spoke highly about the quality of food provided. One person said, 'the food is good'

A visitor to the home told us they could visit at any time and were made to feel welcome. They also said that when they ask for something to be done it happens.

People living in the home were happy with the level of cleanliness throughout the home. One person said 'They are always cleaning, its always lovely and clean'

People said they would talk to the deputy manager or the seniors if they had a problem.