Archived: Victoriana Care Home

Victoriana Care Home is a residential care home providing personal and nursing care to up to 34 people. The service provides support to people who may be living with a physical disability, mental health needs or dementia. At the time of our inspection there were 29 people using the service.

Victoriana Care home is split across three floors. People have access to their own personalised bedrooms and share communal areas such as lounges, bathrooms, dining areas and a garden.

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

There was ineffective leadership at the service and governance systems were not identifying areas where improvements were needed. Audits were either not in place or not effective at identifying where actions needed to be taken. A lack of manager presence at the service had allowed a negative culture to develop which did not promote positive outcomes for people. The provider was not reporting statuary notifications to the CQC in line with requirements. People, relatives and the staff team were not being asked to feed back about the service.

Risks to people were not thoroughly assessed and risk assessments lacked detailed guidance for staff to follow. These included risks relating to fire. There were numerous infection control issues at the service and the home needed some upkeep and a deep clean. Systems were not in place to review accidents and incidents to help ensure people were safeguarded from abuse. There were enough staff to support people safely, however staff were not supported to get to know people well as individuals. People were supported safely with their medicines for the most part.

People did not receive personalised care and there was not a focus on their individual likes, dislikes and preferences. Staff were not trained or knowledgeable about people’s specific health conditions. People were not being supported to engage in social pastimes which they were interested in. Staff interactions with people were task based and there was little effort made to engage with people in a meaningful way. We have made a recommendation to the service around considering best practice when communicating with people.

People were not always treated with kindness and compassion and their privacy and dignity was not always respected. Staff did not always support people to remain independent if this was their choice. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Staff did not always have the right training or knowledge to support people effectively. People were supported to see health professionals, however advice from health professionals was not always recorded in detail in people’s support plans. Changes needed to be made to the environment to help support people living with dementia to orientate. People’s needs were not always reassessed in a timely manner.

Some people gave positive feedback about their care. One person said, ‘‘I really like it here. The staff are genuine and look out for me.’’ People were positive about the food and drink at the service. Some staff spoke with people in a kind way. The management team gave us some assurances they would begin addressing the issues we found at this inspection.

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 requires improvement (published 27 November 2020). The services rating has now changed to inadequate. This service has been rated requires improvement or inadequate for the last two consecutive inspections.

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 the provider remained in breach of regulations.

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.

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 safe care and treatment, safeguarding people from abuse, person centred care, the reporting of notifiable incidents and good governance at this inspection.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Victoriana is a residential care home providing personal care to 21 people at the time of the inspection. The service can support up to 34 people.

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

The home was clean but there were infection control risks due to the upkeep and maintenance of the home by the provider. Staff wore the correct personal protective equipment (PPE) and there were social distancing measures in place at Victoriana. However, we identified some short falls in how cross contamination and COVID-19 risk was managed. The registered manager spoke with the professionals to address these issues. We also found there were insufficient plans in relation to the management of a COVID-19 outbreak and the winter pressures in general.

People received their medicines, but there were some shortfalls too in staff practices in this area of people’s care. In relation to staff not being distracted when administering people their medicines and accurately recording if a medicine was declined or not.

The provider’s quality monitoring processes needed improving in order to identify shortfalls and areas of improvement and take effective action to resolve them.

People and their relatives told us they were happy living at Victoriana. Relatives spoke well of the staff and managers.

We found staff were thoughtful and caring towards people. Staff knew the people they supported and understood people’s mental health needs. They were sympathetic to the difficulties of living with dementia. People were involved in their care and were asked about their views of how their key needs were met by the managers and staff.

Staff had a good understanding about what their role was if they identified any potential harm or abuse. There were risk assessments and plans were in place to guide staff and the managers to respond to the risks which people faced, but sometimes these needed expanding further.

There were improvements made following the last inspection, we could see the managers had worked hard to make these improvements and to respond to COVID-19.

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 Inadequate (the report was published on 15 November 2019). There were multiple breaches of the regulations. 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, but there were still two continued breaches of the regulations.

This service has been in Special Measures since 15 November 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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 inspection was prompted in part due to concerns received about how COVID-19 and the risk of COVID-19 was being managed at the home. As a result, we undertook a focused inspection to review the key questions of safe, caring and well led only.

The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection. We found evidence that the provider needs to make further improvements. Please see the safe, caring and well led sections of this full report. The provider has taken some action to respond to these issues. 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 Victoriana Care Home on our website at www.cqc.org.uk.

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.

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

We found multiple issues in relation to poor hygiene and infection control practices at the home. Key safety risks were not being identified, assessed, and action taken to reduce these potential risks. The management team and provider were not always promoting the safety of people who had a history of mental health needs. When we raised these issues to the registered manager they took action to start to address our concerns.

Staff did not always have a complete knowledge and understanding about how to protect people from potential abuse. Risk assessments for people were not up to date and completed in full. People’s medical creams were not being stored and monitored in a safe way. Recommendations by a provider of fire related equipment had not been acted upon in a reasonable time frame.

People did not speak negatively about the food, but they equally did not speak positively about it, they thought it was ok. The meal experience was basic and was not promoted as a pleasurable experience. The service did respond when people were at risk of being an unhealthy weight.

People had input from health and social care professionals, but key health appointments such as dental and chiropody were not always happening or being effectively monitored to ensure people also had this health input. Staff knowledge and practice was not always complete in terms of managing people’s needs and safety. Staff felt supported by the registered manager and felt they could approach them and raise issues when needed.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service were not always supporting this best practice. The registered manager was assessing people’s mental capacity, but this was not always in line with best practice.

The provider was not promoting people’s dignity in relation to their experience of care and the environment they lived in. Sometimes staff were not respectful to people, at times staff behaved in an institutionalised way with people.

Staff did not routinely engage with people in a friendly and personalised way. They had not formed or tried to form good relationships with people. There was a lack of social stimulation, in terms of conversations activities and events. The management were not trying to promote people’s interests or enable them to form new interests and goals with life.

The provider was not completing robust and meaningful audits and checks of the service. The registered manager told us they felt supported by them. However, we found the provider was not effectively assessing the service, to help improve people’s experiences at the home.

The registered manager was working creatively with some people to promote their independence, ensure they stayed connected to friends and stayed motivated to engage with services provided by health and social care professionals. The registered manager was also supporting people to have holidays. However, this good practice, had not filtered down to all staff and had not influenced the general culture of the home.

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 overall with Requires Improvement in well led (published in 24 April 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the governance of the service, the safety in terms of hygiene and people’s experiences in living at the home.

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.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

This unannounced inspection was carried out on 8 and 13 March 2017, and was completed on 20 March 2017 when we received information we had requested from the provider.

Victoriana Care Home provides care and support for up to 33 people, some of whom may be living with dementia, mental health conditions and chronic health conditions. On the day of our inspection, 18 people were being supported by 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.

People were safe because the provider had effective systems to keep them safe, and staff had been trained on how to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines were managed safely and administered in a timely manner by trained staff. The provider had effective recruitment processes in place and there was sufficient numbers of staff to support people safely.

Staff received effective training, support and supervision that enabled them to provide appropriate care to people who used the service. The manager and staff understood their roles and responsibilities in ensuring that people consented to their care and support, and that this was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). People had nutritious food and they were supported to have enough to eat and drink. They had access to healthcare services when required in order to maintain their health and wellbeing.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible. People were happy with how their care was provided and they valued staff’s support. People’s relatives were complimentary about the quality of the staff who supported their relatives.

People’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices. Care plans had been reviewed regularly or when people’s needs changed to ensure that these were up to date. Staff were responsive to people’s needs and where required, they sought appropriate support from other healthcare professionals. The provider had an effective process for handling complaints and concerns.

The provider had systems to assess and monitor the quality of the service. They encouraged feedback from people, relatives, staff and external professionals to enable them to continually improve the service. People and staff we spoke with were complimentary about the improvements that had been made to the premises and the quality of care provided.

The service provides care and support for up to 33 people, some of whom may be living with dementia, mental health conditions and chronic health conditions. On the day of our inspection, 23 people were being supported by 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.

The provider had effective systems in place to safeguard people. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. Although people’s medicines had been managed safely and administered by staff who had been trained, these were not always given to people in a way that promoted effective treatment. This could have resulted in adverse effects to people’s health and wellbeing.

The provider had effective recruitment processes in place and there was enough staff to support people safely. The manager and staff understood their roles and responsibilities in ensuring that people consented to their care. Where required, they ensured that the care of people who lacked mental capacity to make informed decisions about their care was in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff had received effective training and support, but staff supervision had not always been provided in a timely manner.

People’s needs had been assessed and they had person-centred care plans in place. They were supported to have sufficient food and drinks, but people were not complimentary about the quality of the food and choices provided to them. People had been supported to access other health and social care services when required in order to maintain their health and wellbeing. The provider had failed to follow current guidance on creating a dementia friendly environment.

Staff were kind and caring towards people they supported. They treated people with respect and dignity. As much as possible, they supported people to maintain their independence. There were not enough activities provided to keep people stimulated throughout the day.

The provider had a formal process for handling complaints and concerns. People had been given opportunities to provide feedback about the quality of the service provided.

The provider had effective systems in place to assess and monitor the quality of the service provided. Regular audits had been carried out and actions taken to make the required improvements.

The provider was not meeting the requirements to provide safe and person-centred care because people’s medicines had not always been given in a way that promoted effective treatment. Additionally, people had not been adequately supported to pursue their hobbies and interests.

You can see what action we told the provider to take at the back of the full version of the report.

During our scheduled inspection of Victoriana Care Home on 2 September 2013 we identified non-compliance regarding cleanliness and infection control and safety and suitability of premises. We found that the provider could not fully evidence that the service had effective systems in place which protected people who used the service from, both poor standards of cleanliness and hygiene and unsafe or unsuitable premises. We found evidence of poor standards of hygiene and cleanliness at that time and that the premises posed a potential risk for people. We imposed compliance actions with regards to these regulations and told the provider they needed to make improvements in this area. On 3 December 2013, we carried out an inspection to check that these actions had been implemented.

The provider submitted an action plan, which stated that affected areas of the home, such as mattresses, carpets were to be thoroughly cleaned or replaced with increased monitoring of the environment and that thorough spot checks would be completed. It also confirmed that areas of the property that needed work, would also be rectified. It confirmed that this work would be completed by 21 September 2013.

When we inspected the Victoriana Care Home 2 September 2013, we spoke with six members of staff including the registered and deputy manager. We spoke with four people who used the service, one visiting relative and one visiting professional.

We found that there were effective systems in place to support their workers. We saw that staff received appropriate professional development. One person said, 'They (carers) work very hard, not met one that's not helpful.' We found an effective complaints system in operation. One person said, 'I'm alright, happy, no complaints.'

However, the systems in place to ensure a clean and hygienic environment were ineffective. We confirmed that staff had received training on infection control but we found that this training was not consistently followed in practice. One staff member said, 'Some of the rooms look a little bit tatty.' We also found that the d'cor and rear garden required attention.

We observed that people were offered care and support at a level which encouraged independence and ensured their individual needs were met. There was a relaxed atmosphere in the home and we noted staff interacted confidently with people and were friendly and courteous in their approach to them. We spoke at length with five people who lived at the Victoriana Care Home, all commented positively about the quality of care and the conduct of the staff. One said, "I love it here, I'm content. They got me walking again and this is where I want to stay".

We noted people were encouraged to express their views and were involved in planning their care and making choices and decisions about their care and support and how they spent their time. Within the care files we saw care documentation had been signed by the individual or their representative to confirm their involvement and agreement with their particular care needs.

There were robust systems in place to promote quality assurance in this home. The responses from the 2012 satisfaction survey included many comments which reflected that people were very satisfied with this service.