Victoria Court

People’s experience of using the service: People were supported safely and protected from harm. There were systems in place to reduce the risk of abuse and to assess and monitor potential risks to people.

The management of medicines was safe. Risk assessments were carried out to mitigate potential risks. Incidents and accidents were managed effectively; lessons learnt were shared with staff to reduce the risk of further occurrences.

Staff had the right skills and experience to meet people’s needs. Recruitment checks were completed on new staff to ensure they were suitable to support people who used the service. A comprehensive induction and training programme was completed by all staff.

People were well cared for by staff who treated them with kindness, respect and dignity. People told us they were involved in their care, and what they did on a day to day basis. People's right to privacy was maintained by the actions and care given by staff members.

Assessments were carried out to ensure people’s needs could be met. Staff understood people’s likes, dislikes and preferences and people told us they were offered choices about their care.

Some people using the service required end of life care. Care plans recorded people’s preferences for their end of life care.

Where required, people were supported to maintain a healthy diet and health needs were regularly monitored. Staff followed the advice of health care professionals.

Staff understood their responsibilities in relation to the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive was possible; the policies and systems in the service supported this practice.

Staff told us the management team were honest and supportive. People told us the management team were approachable and felt concerns would be effectively managed. Complaints were managed efficiently.

The provider had embedded quality assurance systems to monitor the quality and safety of the care provided. People were asked for their views and their suggestions were used to improve 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: Requires Improvement (report published 18 May 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Victoria Court is a domiciliary care agency. Victoria Court is a large complex of houses where people can access the domiciliary care agency which is based on site. Not all people living at Victoria court received personal care and we only inspected those people who received a regulated activity. It provides a service to older adults. Not everyone using Victoria Court services receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, eating and medication. Where they do we also take into account any wider social care provided. At the time of our inspection, 17 people were using the service.

There was no registered manager however; the manager of the service had applied to the Care Quality Commission to become the registered manager and that this was being progressed. 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 the last inspection we rated the service overall ‘Good’ however, at this inspection we found that improvements were required and rated the provider ‘Requires improvement’. At the last inspection we found the provider did not always follow The Mental Capacity Act 2005, as capacity assessments and best interest decisions had not been recorded. At this inspection we found some improvements had been made with capacity assessments in place however, not all best interest decisions had been completed, when required. We made a recommendation that the provider research the MCA to ensure best practice is followed.

We found improvements were needed to fully ensure effective systems and processes were in place to monitor and improve the service. Audits did not always identify when actions were required and not always completed in a timely manner. Records were not always robust to show that actions had been completed.

We found risk assessments had not always been followed by staff to ensure people’s safety and avoid potential harm.

Staff did not always receive supervisions and appraisals in line with the provider’s policy however, staff told us they felt supported and were provided with the appropriate training.

Medicines were safely administered most of the time however, medication errors had not always been reported and actions had not been taken to mitigate risks. 'As required' medicines were administered accordingly and protocols were in place for staff to follow.

There were sufficient staffing levels however; some people felt that more staff were required due to waiting times. Recruitment procedures were safe for employed staff however, the relevant checks to ensure agency staff were eligible to work with vulnerable people had not always been completed.

People told us they felt safe and staff had a clear understanding of the procedures relating to safeguarding and whistleblowing. People told us staff were kind and they felt listened to by staff. Staff respected people’s privacy and dignity at all times.

People were supported with their health and nutritional needs and were provided with a range of food and drink.

People were encouraged to remain independent and make choices about their care. Care plans were detailed and included people's preferences and likes and dislikes, which promoted person centred care.

Complaints had been responded to with outcomes recorded. People using the service told us they felt confident to discuss any concerns with the provider. Incidents and accidents that had been reported were monitored and managed effectively.

Surveys were provided to people to gather their views of the service. The provider had a ‘you said, we did’ document which allowed people to see the changes made by the provider.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, (Good governance) and (Safe care and treatment). You can see what action we told the provider to take at the end of the full version of this report.

The service comprises of 50 apartments with communal areas which include a library, atrium and a bistro. The service is registered to provide personal care to older people in their own apartment if they require this.

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.

There were systems and processes in place to protect people from the risk of harm. Staff were aware of the different types of abuse and what would constitute poor practice.

Safety checks of the building and equipment had been completed appropriately.

Assessments were undertaken to identify people’s care and support needs. Care records reviewed contained information about the person's likes, dislikes and personal choices.

There were risk assessments in place for people who used the service. The risk assessments and care plans had been reviewed on a regular basis, but at times the care plan had not been updated following a change in need. Recognised tools to assess risks around nutrition and pressure care were not being used.

The registered manager and staff we spoke with had an understanding of the principles and responsibilities in accordance with the Mental Capacity Act (MCA) 2005. We found capacity assessments and best interest decisions were not always recorded in peoples care records.

Systems were in place for the management of medicines so people received their medicines safely. The audit process did not check frequently enough people’s medication charts which meant errors were not highlighted in a timely way.

There were enough staff employed to provide support and ensure people’s needs were met. Effective recruitment and selection procedures were in place and we saw appropriate checks had been undertaken before staff began work.

Staff told us the registered manager was supportive. Staff had received regular and recent supervision and most had received an annual appraisal. Staff training was up to date.

People and families told us staff treated people with dignity and respect. Staff showed compassion, were patient and gave encouragement to people.

People told us they had access to a wide range of activities and people told us they enjoyed them.

People were provided with their choice of food and drinks which helped to ensure their nutritional needs were met.

Staff at the service worked with other healthcare professionals to support the people. Staff worked and communicated with social workers, occupational therapists, hospital staff as part of the assessment and on-going reviews. Care plans did always contain robust health needs information.

The registered provider had a system in place for responding to people’s concerns and complaints. People told us they knew how to complain and felt confident staff would respond and take action to support them.

There were systems in place to monitor and improve the quality of the service provided. Staff told us the service had an open, inclusive and positive culture

People told us they were given information about the service and met with a member of staff who checked that they understood the support available. People's needs were assessed before they started to use the service. Where appropriate, relatives had been involved in the assessments and support planning. There were arrangements in place to deal with emergencies. Staff were had received Basic Life Support training and knew how to summon assistance and support people who were unwell.

People were protected from the risk of abuse. The provider had taken reasonable steps to ensure staff, relatives and people who used the service were able to identify signs of abuse and knew how to report concerns about abuse.

Appropriate arrangements were in place in relation to the supply, safekeeping, administration and recording of medicines administered by the staff.

Staff received appropriate professional development. They had undergone a structured induction period, had regular supervision and felt well supported by the manager. Staff training and development needs were identified and staff were encouraged to obtain further qualifications.

The provider had an annual audit programme detailing specific tasks to be completed each month. Monthly resident and service user meetings had been held. People had been able to raise issues of concern and receive feedback about issues they had previously raised. One of the people we spoke with said, 'The residents meetings are good, the staff take notice."