New Victoria Nursing Home

New Victoria Nursing Home is a care home providing personal and nursing care to 27 people at the time of our inspection. The service can support up to 30 adults living with dementia or mental and physical health conditions. Accommodation consists of single room accommodation with additional communal spaces for people’s comfort and enjoyment.

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

The service was not always safe. We found care records were not always accurate. Where risks to people were identified, recorded documentation to lessen the risk was not in place. We found concerns with the cleanliness and maintenance of the environment we have made a recommendation around this.

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 support this practice.

The governance and quality checks in the home did not consistently promote the delivery of safe care and treatment. The registered provider had not established good governance in line with best practice and to ensure compliance with regulations.

The service was caring. One person told us, " Yes, they [the staff] are extremely caring." We observed positive interactions between people. Staff and people were comfortable in each other’s company. Staff treated people with respect and upheld their privacy and dignity. Staff knew people well and encouraged them to be as independent as possible.

People told us they felt safe. There were enough staff to meet people's care and support needs. Staffing levels were increased if people required additional care. The service worked with a wide range of key organisations who were also involved in people's care.

There was a positive staff culture at the service and staff were happy in their roles. People, relatives, and staff were complimentary about the registered manager.

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 requires improvement (published 19 August 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

At our last inspection made a recommendation about the safe management and recording of medicines. At this inspection we found although improvements had been made there were still improvements to be made.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, medicines and the management of the home. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, documentation, governance, recruitment and consent at this inspection.

We have also made a recommendation the provider considers current guidance in relation to infection prevention and control.

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 and request an action plan 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 alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

New Victoria Nursing Home is a care home providing personal and nursing care to 25 people at the time of our inspection. The service can support up to 30 adults living with dementia or mental and physical health conditions. Accommodation consists of single room accommodation with additional communal spaces for people’s comfort and enjoyment. New Victoria Nursing Home will be referred to as New Victoria within this report.

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

Staff did not always follow safe recordkeeping associated with medicines management.

We have made a recommendation about the safe management and recording of medicines.

The provider was in the process of a renovation and redecoration programme to enhance people’s safety and welfare. They deployed sufficient staffing levels to meet people’s needs in a timely way. Staff were able to describe good practice in safeguarding principles to protect people from harm, injury or unsafe care. Staff followed current guidance to maintain good infection control measures.

The registered manager implemented personalised care to assist staff to prevent malnutrition. Staff further promoted healthy living by working alongside external health and social care professionals. 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. The registered manager trained staff to develop their skills.

The registered manager demonstrated they had taken sufficient action in the ongoing improvement of care and quality assurance records. They led the home in a programme of development and reflection focused on continuous learning. Staff confirmed the registered manager was a strong, competent leader.

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 16 April 2021) and there was a breach of regulation. 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 and the provider was no longer in breach of regulations.

The service remains rated requires improvement.This service has been rated requires improvement for the last two consecutive inspections.We found action had been taken to improve the leadership and safety of the home. However, we rated the key areas as requires improvement because the management team and staff need to demonstrate consistent good practice over time.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels; environmental safety; staff training; supporting people living with dementia to have meaningful lives; nutrition; personalised care planning; and leadership. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for New Victoria 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.

New Victoria Nursing Home is a care home providing personal and nursing care for up to 30 people. The home is set on three levels. There are two lounges located on the ground and third floor. Bedrooms are located on all three floors and are single accommodation.

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

People could not be assured governance systems were sufficiently implemented and embedded to drive improvements at the home. Risk controls were not always documented.

People were supported by staff who had undergone sufficient recruitment checks to help ensure they could support people who may be vulnerable. The manager was reviewing staffing arrangements to ensure the current arrangements met people’s needs. Staff had received training in key areas such as moving and handling and infection prevention control to maintain their skills and competence.

People received their medicines safely. If people needed medical advice this was arranged for them and changes made to their care to support their well-being. Staff knew the help people needed to remain safe and people spoke highly of the staff.

Rating at last inspection (and update)

The last rating for this service was Good (published 23 November 2019). We also carried out a targeted inspection on the 03 November 2020. This was to ensure Infection Prevention and Control practice was safe and the service was complaint with IPC measures. During the targeted inspection we found improvements were required, and the provider was in breach of regulations.

At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We received concerns in relation to the management of people’s nursing care needs. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

In addition, this inspection was carried out to follow up on action we told the provider to take at the last inspection carried out on 03 November 2020. We checked whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on a specific concern we had about infection prevention and control.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

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.

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

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to good governance and documentation at this inspection. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report and the action we have told the provider to take at the end of this report.

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.

As part of the inspection process, we requested documentation to be sent to is to inform our judgement. We have taken this into account when making our judgement.

¿ The provider had not done all that is reasonable to lessen risk. Staff were not always provided with training in infection prevention and control and risk assessments did not always key areas such as underlying health conditions. This was a breach of regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

We discussed this with the provider. They told us they would ensure staff undertook training and they would review the risk assessments in place.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

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

We found the following examples of good practice.

¿ Staff supported people to use electronic tablets and telephones to maintain contact with loved ones.

¿ Adequate handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support best practice.

¿ People were supported to access health professional advice through the use of technology.

¿ The service was taking part in the whole home testing process. People and staff were offered the opportunity to participate.

Further information is in the detailed findings below.

New Victoria Nursing Home is a residential care home providing personal and nursing care to 24 people at the time of the inspection. The service can support up to 30 people. The home is purpose built and is set on three levels. There are two lounges located on the ground and third floor. Bedrooms are located on all three floors and are single accommodation.

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

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People were happy living in the home and felt safe. Risks were well managed. Staff were recruited in a safe way and there were enough staff deployed to meet people's needs. Arrangements were in place for the safe administration of medicines. People were protected from the risk of infection as prevention and control measures were in place.

People's needs were assessed, and care and support had been planned proactively and in partnership with them. People were provided with a nutritious and varied diet. Staff were suitably trained and received regular supervisions. 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 were treated with dignity and respect and their privacy was maintained. People said staff were kind and caring and knew and met their care needs. People were encouraged to be as independent as possible and were supported to maintain important relationships. The registered manager provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed and where support was required these had been met. People were entertained and stimulated by the activities provided for them. People knew how to complain, and any complaints received were fully investigated and subsequent action was taken.

The registered manager worked in partnership with a variety of agencies to ensure people received coordinated care which met their needs. People were happy with how the service was managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at 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 (published 03 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

People who lived at the home told us they were happy with their care and liked the staff who looked after them. One person said, “Yes I am happy here. The staff are very nice and they look after me.”

We observed staff providing support to people throughout our inspection visit. We saw they were kind and patient and showed affection towards people in their care.

We saw people who lived at the home were clean and well dressed. They looked relaxed and comfortable in the care of staff supporting them.

People who lived at the home and their visitors told us they enjoyed a variety of activities which were organised for their entertainment.

Staff knew people they supported and provided a personalised service. Care plans were organised and had identified the care and support people required. We found they were informative about care people had received.

We saw staff assisting people with mobility problems. They were kind and patient and assisted people safely.

People told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People had access to healthcare professionals and their healthcare needs were met. We saw the service had responded promptly when people had experienced health problems.

We found staff had been recruited safely, appropriately trained and supported. They had the skills, knowledge and experience required to support people with their care and social needs.

The service had sufficient staffing levels in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. People who lived at the home told us staff were responsive to their needs.

Staff spoken with and records seen confirmed training had been provided to enable them to support people who lived at the home. We found staff were knowledgeable about support needs of people in their care.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

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

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

We looked around the building and found it had been maintained, was clean and hygienic and a safe place for people to live. We found equipment had been serviced and maintained as required.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

The service had a complaints procedure which was made available to people on their admission to the home and their relatives. We saw the registered manager had listened and responded to issues of concern raised by of one person who lived at the home. The concerns were being investigated when we undertook our inspection visit.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff and resident meetings to seek the views of people about the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. We also spoke with Blackpool council's contracts monitoring team and Healthwatch Blackpool who are an independent consumer champion for health and social care.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe and their rights and dignity was respected. They told us they were receiving safe and appropriate care which was meeting their needs. Safeguarding procedures were in place and staff understood how to safeguard people they supported. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff understood when an application should be made and in how to submit one. This meant that people would be safeguarded as required.

The service was clean and hygienic. Equipment had been maintained and serviced regularly ensuring people were not put at unnecessary risk. People living at the home told us they were happy and well looked after.

We looked at the recruitment of new staff. The information retained in the files we were given showed that some required recruitment checks had not been undertaken. We found gaps in employment history were not being explored at interview. This meant the home did not have a full employment history of the people employed. Of the three files we looked at two had no references from previous employers. We also found information about when the person's Disclosure and Barring Service checks (DBS), (formerly CRB checks) had been received had not been recorded. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to recruiting new staff.

Is the service effective?

People's health and care needs had been assessed with them. Specialist dietary needs had been identified where required. Care plans had risk assessments completed to identify the potential risk of accidents and harm. Staff members we spoke with confirmed guidance was provided to ensure they provided safe and appropriate care. We found the care plans were flexible, regularly reviewed for their effectiveness and changed in recognition of the changing needs of the person.

Is the service caring?

People were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. The people we spoke with were happy with the care being provided. One person said, 'They look after me really well. We only have to ask if there is anything we want. I enjoy the meals and I am happy with my care.' Another person said, 'I am quite happy. The food is good and I find the staff are kind. My only negative comment is I would like to get out more.' Care plans had been maintained recording the care and support people were receiving. Good care practices were observed and people told us they were happy with the support they were receiving.

Is the service responsive?

Records showed admissions to the home were well planned. Information about people's care and dietary needs had been recorded. We also saw potential risks to people's health and welfare had been identified. Guidance had been provided for staff to ensure they provided safe and appropriate care.

We found people had access to healthcare professionals. People received regular health checks with their General Practitioner and the outcome of these visits were recorded on their care records.

A number of people we spoke with said there was very little going on in the home and social activities were limited. One person said, 'We have an entertainer visit us occasionally but other than that we have nothing going on. The days just seem to roll into each other. It would be nice if the staff could find time to spend with us but they are always too busy.' Another person said, 'It would be nice if we had some activities to keep us entertained. Most people spend their time asleep in the lounge.' We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's individual needs.

After lunch we saw one person who had a stained cardigan after spilling some of their meal on themselves. We noted staff had not changed the person's cardigan or made any attempt to assist in cleaning them when we last saw them at 4.30pm. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to meeting people's individual needs.

Is the service well-led?

There were limited records available to show how identified problems and opportunities to change things for the better were addressed promptly. There were no procedures in place to gather information about the safety and quality of service provided. People supported were not asked for feedback about the quality of service they received. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to having systems in place to monitor the home.

CQC had not been notified of any incidents or issues relating to the home since October 2013. This meant that we did not receive all the information about the home that we should have done. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to providing information as required.

Although registered for the regulated activity personal care the service was not providing this activity when we undertook this inspection.

Throughout the inspection we found shortfalls in medicines handling such as inaccurate recording keeping, disorganised medicines records, lack of medicines disposal records, insecure medicines storage, missed medicines and lack of information about when required medicines. The manager was unaware of these issues so there was a risk medicines handling would not improve. This placed the health and wellbeing of residents at unnecessary risk.

During this inspection we found the home's medicine policy had been reviewed and regular audits had been completed to help ensure that medicines were safely handled. The manager had also introduced spot checks to record the competences of nursing staff administering medicines within the home.

The people we spoke with said they were receiving safe and appropriate care which was meeting their needs. One person said, 'I looked around a few homes with my family and we liked this one. The staff are pleasant and I have no issues with my care'. Another person said, 'The girls are all nice. I find them kind and helpful'. We observed the routines within the home were being arranged around people's individual and collective needs. We saw the staff were kind and caring when providing support.

Overall we found medicines were not safely handled potentially placing people at risk.

During our inspection we contacted the Blackpool contracts monitoring team. They told us they currently had no concerns with the care being provided by the home.

"I find all the staff are very helpful and friendly. I am very happy with my care".

"I prefer to stay in my room as I like to watch television and read. I have a call bell to request assistance if I need anything. The staff are always popping in to check on me and respond quickly if I call them".

"The care is very good here. I have stayed in other homes but this one is much better. I find the girls are hard working and very kind. They look after me very well".

"I am very happy with my choice of home. I don't want for anything and I am being well looked after. The staff can't do enough for me. The manager is always calling in to check on me and ask if I am alright".