This inspection took place on 31 July and 7 & 14 August 2015 and was unannounced. Victoria House Care Home provides accommodation and personal care for up to 23 people who are older or who have dementia. Some people had health needs such as diabetes, and others needed support with their mobility. There were 16 people living at the home at the time of our inspection.
The home 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.
Most of the people we spoke with said they felt safe living in the home. However, we found a number of significant safety concerns during our inspection. Staff and the registered manager were not clear what their responsibilities were to safeguard people from abuse. We raised six safeguarding concerns with the local authority during our inspection.
Risks to people’s safety were not properly assessed, and management plans that were in place were poor. Examples included falls, risk of malnutrition and risk of developing a pressure ulcer. Action was not taken when risks to the property had been identified, including fire and legionella. Where environmental risks had been identified the provider failed to take appropriate action. The provider did not have a suitable schedule in place to ensure that essential maintenance tasks were completed when required. Incidents and accidents were not properly documented or investigated, and appropriate action was not taken to prevent the incident from re-occurring,
People were not kept safe and did not have their needs met because there were not enough staff. The registered manager and provider did not assess the level of people’s care needs to determine what staffing levels were appropriate to keep people safe. People said “we need more staff” and “at weekends staffing is bad.” While staff tried their hardest they did not have the time they needed to do anything other than meet people’s basic care needs. On person said: “carer’s are really nice, but they don’t have enough time to talk to you”.
People’s medicines were not safely managed. One person did not get their prescribed medicines for eight days because they were out of stock. People were being given medicines regularly when they had only be prescribed on an as and when basis. Medicines administration records were not always completed so it was not possible to establish if people had received their medicines. Medicines were not always stored securely. On several occasions the medicines cupboard was left unlocked and we found a large number of paracetamol in an unlocked drawer in the manager’s office.
Staff were not properly supported with training, supervision and appraisal. Staff had not received training in appropriate subjects such as the Mental Capacity Act (2005) (MCA) and caring for people with dementia. There was no schedule in place for when out of date training would be completed and supervision and appraisals were not up to date. Recruitment practices were not robust and not all of the required information was obtained from staff before they began working for the provider.
Staff were not clear of their responsibilities under the MCA. People’s level of capacity had not been appropriately assessed and information about best interest’s decisions was not recorded accurately. Not all of the relevant Deprivation of Liberty safeguards (DoLs) applications had been made. Where a DoLs had been granted information about the conditions of the DoLs were not recorded in people’s care plans and staff were not aware of what they were. Where a person had Lasting Power of Attorney in place this was not always recorded properly.
People did not have their hydration needs met. People were not offered fluids on a regular basis during the day and did not have access to water or other drinks, except at mealtimes. People’s fluid and nutritional intake was not properly monitored. People did not always have access to health care services. Two people had missed hospital appointments because transport was not organised in time, and other appointments were not accurately recorded in the homes appointment diary. People’s medical conditions were not well understood by staff and appropriate referrals to health care professionals were not always made.
People told us staff were caring. One person said: “the care is very good. If you ask them (staff) anything they will tell answer you”. However we found that people’s care needs, choices and preferences were not understood by all staff. People’s privacy and dignity were not protected and we observed several occasions where people were not supported with their personal hygiene needs in a dignified manner.
People were not always involved in the assessment and planning of their care needs. People’s care plans and records were contradictory and out of date. Staff did not have access to accurate care plans to enable them to meet people’s identified needs. Information about changes in people’s needs was not communicated between staff and people’s needs were not regularly reviewed.
Although the provider had a complaints policy in place, this was not readily available for people and staff to refer to. Complaints were not always recorded or investigated appropriately, and action was not taken to ensure comments or concerns raised were used as an opportunity for learning.
Activities for people using the service were limited. People were not supported to take part in hobbies or other activities that were important to them. All of the people we spoke to said they would like to go on an outing, such as to the shops or for a meal. People were not supported to leave the home and be involved in the community, except when they were attending a medical appointment.
Leadership was not visible from the provider or registered manager. They did not understand their responsibilities and quality monitoring was poor. Many of the issues highlighted at this inspection had not been identified by the registered manager or provider. Records were inaccurate and not always kept securely. Not all of the relevant notifications had been sent to CQC as required by law.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.