Archived: Victoria Lodge

Victoria Lodge is based in a residential area of Saltburn within walking distance of the sea front. The home provides personal care for people living with a mental health illness. The service is registered for 14 people and on the day of our inspection there were 12 people using the service.

At our last inspection in July 2016 we found the service was in breach of registration and was rated as ‘requires improvement’. We found during this inspection that the provider had made improvements to their best interest decision processes and recording and had recruited a new manager.

We found quality assurance surveys took place, to check people’s views of the service The service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues. People who used the service and their representatives were regularly asked at meetings for their views about the care and service they received.

The service did not have a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

A manager was newly appointed to the role and at the time of our inspection was in the process of registering with the CQC.

The atmosphere at the service was relaxed and very welcoming. People who used the service told us they felt at home and had a good rapport with the staff and the providers.

We saw staff interacting with people in a person centred and caring way. We spent time observing the support that took place in the service. People were always respected by staff and treated with kindness. Staff communicated with people well and where necessary used their skills positively to reassure people who used the service.

We found the service adhered to the principles of the Mental Capacity Act 2005 and where people were unable to make decisions for themselves, best interests’ decisions had been put in place. These had involved social workers, family members, advocates and other professionals.

People were encouraged to enhance their wellbeing on a daily basis by taking part in activities that they valued. Staff spent their time positively engaging with people on an individual basis in meaningful activities. People were supported to go out regularly too.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice.

People’s care plans were written in plain English and they also included a personal history and described individuals preferences and support needs. These were regularly reviewed and were written in a person centred way. ‘Person centred’ is when a person is at the centre of planning their care and their preferences are respected.

Care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care plans showed that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, chiropodist, mental health practitioners, dentist or optician.

People who used the service were supported on a one to one basis or by sufficient numbers of staff to meet their individual needs and wishes in a person centred way.

Staff training records, showed staff were supported and able to maintain and develop their skills through training and development opportunities that were accessible at the service. The staff confirmed they attended a range of learning opportunities.

Staff had regular supervisions and appraisals with the deputy manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. Records that showed there were robust recruitment processes in place. However, some staff records were not always complete; this was rectified during the inspection.

We observed how the service administered medicines. We looked at how records were kept and spoke with senior care staff who administered medicines and we found that the process was safe.

People were encouraged to eat and drink sufficient amounts to meet their needs. They were offered a varied selection of drinks and homemade snacks. The daily menu was flexible and reflective of people’s likes and dislikes and offered varied choices and it was not an issue if people wanted something different.

A complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had their rights respected and access to advocacy services if needed.

At the last inspection on 20 and 26 October 2015 we found the service was not meeting all the requirements of the Health and Social Act 2008. There were gaps in the records of maintenance and safe systems were not in place for hazardous substances. We also found that safe staffing levels were not in place and training was not up to date. The service had no registered manager in post and quality assurance processes were not regularly completed therefore the service did not show good governance. Some records were inaccurate or incomplete.

Victoria Lodge is a large converted terraced house in the centre of Saltburn. The service can provide care and support for up to fourteen adults who have a mental health condition. At the time of inspection only eleven people were living at the service. The service is close to all local amenities. It is located on a quiet residential street and services are provided over three floors. There is a rear courtyard and on street parking.

The home has not had a registered manager in post since 27 February 2015. 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 a 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 time of the inspection the registered provider was supporting the service on a day to day basis.

Safeguarding alerts had been made when needed. Staff understood the procedure they needed to follow if they suspected abuse might be taking place.

Risk assessments were in place for people who needed these and they were specific to people’s needs and were regularly reviewed. Staff understood that people could take reasonable risk.

Emergency procedures were in place for staff to follow and personal emergency plans were in place for everyone. A new robust procedure for recording fire drills had been implemented.

Robust recruitment procedures were in place and appropriate checks had been made for newly recruited staff.

There were sufficient staff on duty. People told us there was enough staff on duty day and night to meet their needs. A dependency tool was used to determine safe staffing levels.

Medicines were managed appropriately. The service had policies and procedures in place to ensure that medicines were handled safely. Medication administration records were completed fully to show when medicines had been administered and disposed of. However, there was no clear record within the medication administration records, of where creams should be applied

Certificates were in place to ensure the safety of the service and the equipment used. Maintenance and fire checks had been carried out regularly by the service. However the stair lift service maintenance certificate was not up to date. The registered provider has since taken action to correct this.

Staff performance was monitored and recorded through a regular system of supervision and appraisal. Staff had received up to date training to support them to carry out their roles safely and had completed an induction process with the provider. People told us they felt staff had the knowledge and skills needed to care for them.

People were supported to maintain their health. People spoke positively about the nutrition and hydration provided at the service. Staff understood the procedures they needed to follow if people became at risk of malnutrition or dehydration.

Some staff demonstrated good knowledge and understanding of the requirement of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and knew what action they would take should they suspect a person lacked capacity. However, documentation was not always in place to support best interest decisions.

Each person was involved with a range of health professionals and this had been documented within each person's care records. From speaking with staff we could see that they had a good relationship with the health professionals involved in people's care.

People told us they could spend time with other people in the lounge area or spend time in private if they wished. During our inspection the lounge space was able to accommodate those people who wished to use it. People had spacious bedrooms which included their personal possessions.

People spoke highly of the service and the staff. People said they were treated with dignity and respect.

People, and where appropriate their relatives, were actively involved in care planning and decision making; this was evident in signed care plans. Information on advocacy was available should it be needed.

Care plans detailed people’s needs wishes and preferences and were person centred. People’s life history was documented. Care plans were up to date and regularly reviewed.

There was no evidence of any planned activities taking place on the day of inspection. People had been on day trips to Whitby and other day trips were in the process of being planned.

The registered provider had a clear process for handling complaints. There had been no complaints received in the last twelve months.

Staff told us they enjoyed working at the service and felt supported by the registered provider. Staff told us they were confident any concerns would be dealt with appropriately. We could see from our observations and from speaking to people and staff that the registered provider had a visible presence at the service.

Quality assurance process were in place however these lacked detail and it was unclear from the documents we looked at what areas had been audited and what actions had taken place as a result.

Accidents and incidents were monitored to identify any patterns and appropriate actions were taken to reduce risks. However the recording of falls was difficult to audit and monitor if any trends were occurring.

Feedback from staff and people who used the service was not regularly sought. Meetings had taken place regularly but surveys had not been distributed for a long period of time. The registered provider took immediate action to correct this and action plans have been developed as a result.

The service worked with various healthcare and social care agencies and sough professional advice to ensure that the individual needs of the people were being met.

The registered provider understood their role and responsibilities. Notifications had been submitted to CQC in a timely manner. Notifications are documents about changes, events or incidents the provider is legally obliged to send us within required timescales.

The inspection team consisted of one inspector. During the inspection, we spoke with five people out of 13 people living at Victoria Lodge, the proprietor, the manager and three staff. We looked at three sets of care records and four staff files. We also observed care practices within the home.

The management of the home was good and we saw strong leadership in place and a positive environment for people and staff. Staff spoke highly of their manager and the support which they received.

We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Everyone we spoke with told us they felt safe and secure living at the home. Staff we spoke with understood the procedures which they needed to follow to ensure that people were safe.

Victoria Lodge was clean, hygienic and well maintained; although the provider may wish to note that the downstairs toilet needed resealing and the boxed in work needed updating and painting. At the time of our visit there was scaffolding in place as re pointing work was been carried out. There were good processes in place that ensured infection prevention and control of the home.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care home. While no applications had been submitted to the local authorising authority, the home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards and there was evidence to show that this had been followed appropriately. Staff had received training in relation to these topics along with the safeguarding of vulnerable adults and had an understanding of the actions to take. This meant that people were safeguarded as required.

Peoples care plans were person centred and provided information on their personal life history, who and what is 'important to me' and 'how I would like you to meet my needs.'

Is the service effective?

Everyone had their needs assessed and had individual care records which set out their care needs.

It was clear from our observations and from speaking with staff that they had a good understanding of the care and support needs of people living at the home and that they knew them well. Assessments included mental health, needs for any mobility aids, specialist dietary requirements and road safety assessments.

People spoke highly of the staff and said that they were happy with the care that had been delivered and their needs had been met.

People had access to a range of health care professionals some of which visited the home and all was documented in the care files.

People were encouraged to maintain links with their local community and we were told that the people who used the service liked visiting 'mind' where there were activities such as a disco on a Tuesday night.

Is the service caring?

People were supported by kind and attentive staff who showed patience and gave encouragement when supporting people, whilst helping them to remain independent.

Care plans were individualised and included people's preferences, interests, aspirations and diverse needs. Our observations of the care provided showed that staff were very knowledgeable about people's needs and wishes.

People told us that they were happy with the care and support provided to them.

Is the service responsive?

There was clear evidence contained within people's care plans to show how they worked with other health and social care professionals.

People told us that they knew how to make a complaint if they needed to.

The home was responsive to people's needs, wishes and preferences. We saw that the people who used the service could come and go as they pleased.

Is the service well-led?

There were systems in place to assure the quality of the service they provided. The way the service was run was regularly reviewed. Actions were put in place when needed and we were able to see that these actions had been addressed.

Regular audits were carried out which were used to identify changes and improvements to minimise any risks to people and staff.

We saw people had completed a customer satisfaction survey. This was reviewed and an action plan developed where needed.

There were enough staff on duty at all times and staff had time to sit with the people who used the service.

What people said:

People who were able to express their views told us they were satisfied with the care and support they received. One person told us, 'The staff are nice, friendly, helpful people.' And another said, 'The manager is nice, she is motherly and understanding.'

Everyone we spoke with told us they enjoyed living at the home and they were happy with the care provided. People told us, 'It's the best home I have ever lived in.' and 'The staff understand me and make me feel better.'

Staff told us they enjoyed working at Victoria Lodge. Staff spoke highly of their team and of their manager. One staff member told us, 'I feel very supported; the manager helps me with everything.' Another told us, 'It's like a nice family all in one place.'

One person said; 'I've been here thirteen years, I've got no complaints here, my Mam likes coming here to see me'

Another person commented; 'I feel safe here, it's very friendly here.'

People told us they were happy with the care and support they received. For example, one person remarked;

" I'm independent, I shower myself and I go shopping.'

Another person said; 'I set the tables, I make the tea, I take turns dusting and washing up.'

People also made positive comments about the staff, and the comments we heard included: 'Me and the staff, we are a team." and 'The staff are lovely here'

The atmosphere in the home was relaxed and happy; we heard lots of laughter and observed warm and kind interactions between staff and residents