Victoria Court

Victoria Court is a residential service providing personal care for up to 6 people with learning disabilities, mental health support needs and autistic people. The service consists of an adapted building, which includes individual bedrooms, communal spaces and an accessible outdoor space. At the time of our inspection there were 6 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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. Staff supported people with their medicines in a way that promoted their independence. People had a choice about their living environment and were able to personalise their rooms. The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment.

Right Care:

The service had plans and guidance for staff to support people with their individual risks. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Culture:

The provider had systems in place to monitor the quality of the service to people. However, we found quality assurance systems were not being completed regularly to ensure quality and potential safety issues were identified and acted upon. People received support from staff who knew them well. The service enabled people and those important to them to work with staff to develop the service. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 23 July 2019) and there was a breach of regulation 17. At this inspection we found the provider remained in breach of this regulation. This service has been rated requires improvement for the last two consecutive inspections.

At our last inspection we made recommendations regarding the management of medicines and mental capacity assessments. At this inspection we found the provider had acted on these recommendations and improvements had been made.

Why we inspected

We carried out an unannounced inspection of this service on 4 and 6 June 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement

We have identified a repeated breach of Regulation 17 (Good Governance) at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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 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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service: People were supported in a homely environment and by caring staff. The service was clean and tidy. Recent refurbishment had occurred of the kitchen and hallways.

Care and support were person centred and reflected people’s individual choices and wishes. The service was flexible in meeting peoples changing needs. People were supported to shop and prepare food or meals were provided.

Medicine administration required improvement to ensure best practice guidance was followed. Systems were in place to monitor the quality of the service. However, identified actions had not always been completed. This meant that shortfalls found at this inspection had not been addressed.

Staff spoke positively about the ethos of the service, the induction they received, and the ongoing training provided. Positive feedback was received about the registered manager and their approach to staff and people.

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. However, we found mental capacity assessments and best interest decisions were not always regularly reviewed.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

Rating at last inspection: The last rating for this service was Good (published 30 November 2016).

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

Enforcement: We have identified a breach in relation to good governance at this inspection. We have made two recommendations in relation to medicines and following recommended guidance in the review of mental capacity assessments and best interest decisions. Please see the action we have told the provider to take at the end of this report.

Follow up: 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 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.

Victoria Court provides accommodation and personal care for up to six people who do not have nursing needs. At the time of the inspection there were six people living at the home. Victoria court is set over two floors. The ground floor has two bedrooms, along with two communal lounges, the laundry room, a dining area, kitchen and access to the outside patio area. The first floor has four rooms, the manager’s office, a staff sleeping area, and medication room. All bedrooms are en-suite.

At the time of this inspection the registered manager had just left. 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 had detailed care plans that were personalised to them. They had risk assessments and support plans that gave staff guidelines to follow. Staff knew people well and were able to demonstrate a sensitive and caring approach when people required staff support. People’s personal evacuation plans had details of what support the person might require in an emergency.

People were supported by staff who had checks completed prior to commencing their employment. People felt safe and staff were able to demonstrate what action they would take should they have concerns to people’s safety. People were supported by staff who received regular supervision and training to ensure they were competent and skilled to meet their individual care needs.

People received their medicines safely and when required by staff who had received training. Although one person required a support plan in place relating to their diabetes care. People were supported by adequate staffing levels and staff supported people in a kind and caring manner. Staff demonstrated they knew people well and felt supported and able to raise any concerns with the management of the home.

People were able to make decisions about the care they received and were enabled to be independent. Changes to people’s care needs were identified and planned with them and their care plans were amended to reflect those changing needs. The service was flexible and people and relatives views were sought so improvements could be made. People were happy with the care and felt able to raise a complaint if they had one. People were able to access the community when they wanted and the provider promoted relationships with friends and family.

The provider had a quality assurance system to monitor the quality and safety of the service. Although it wasn’t always effective at identifying areas for improvement for example, deprivation of liberty safeguarding’s that had expired, areas of improvement to the building and appliances that needing testing.

We have made a recommendation that the provider seeks guidance about effective audits for the home.

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.

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

Is the service safe?

People were supported by staff who had received training in safeguarding adults. Staff we spoke with confirmed they knew what actions to take if they witnessed or saw abuse and how they would report it.

We saw the home had undertaken a range of risk assessments for each person. Some of these risk assessments had just been completed and required a date and signature. We found one person did not have a risk assessment relating to one area of risk in their life. We fed this back to the registered manager. They confirmed they would undertake this risk assessment and would sign and dating those that required it.

We observed the laundry environment was unsafe and posed a risk to infection control. We saw that the laundry room required tiles and a new skirting board. There was a broken unsealed floor that had red disposable soiled linen bags on top of it. We saw the home was not ensuring the safe procedure for soiled laundry was followed as dirty laundry was stacked in baskets on top of each other. There was also an extractor fan covered in dust and dirt. A compliance action has been sent in relation to this and the provider must tell us how they plan to improve.

CQC monitors the operation of Deprivation of Liberty Safeguards which applies to care homes. There were no current applications in place at the time of this inspection however we have highlighted a restrictive practice that the provider needs to review.

Is the service effective?

We saw staff provide positive interactions with people. They spoke with people in a polite and calm manner. People spoke positively about certain staff. Relatives spoke positively regarding their experience of the service.

We saw person centred care plans that identified people's individual goals. Where people could make decisions this was recorded in their care plan. We saw the home had undertaken best interest decisions and consulted family, relatives and significant others into decisions that were being made. The provider might wish to note that although there was evidence that a best interest decision was made, there was no evidence that a formal mental capacity assessment under the Mental Capacity Act 2005 had been undertaken.

We saw people's care had detailed guidelines for staff to follow. Staff confirmed these guidelines. This meant that people received care and support that met their individual care needs.

Is the service caring?

Staff we spoke with told us how they supported and cared for people with varying levels of communication needs. They said 'I use hand signals and picture exchange communication cards as well as visual aids'. They also told us what choices they gave people, 'I offer choice about activities and planning the meals'. We spoke with another member of staff who told us 'I use picture exchange communication cards with X, and offer visual items such as a hot drink or cold one'. They also confirmed how they would adapt their communication to suit the individual, 'I give basic communication to X so that I don't over load them with too much information'. This meant that staff were skilled in using different communication techniques in order to engage with people, this enabled staff to provide appropriate support.

Is the service responsive?

People had access to daily and outside activities. They could choose what activities they wanted to undertake. One person said 'I am going to the dentist today, I made the appointment myself'.

Records confirmed that people's personal preferences, interests and their goals and wishes were known.

Is the service well-led?

Relatives we spoke with said how happy they were with the service. They told us 'I am very very satisfied'. They confirmed 'staff care exceedingly well for X'. Another relative told us 'It's better now than what it was'.

Two people we spoke with told us how they have problems accessing the washing machine as it is always busy. They told us 'I can't always use the washing machine as it's busy' and 'the washing machine is always in use'. We fed this back to the manager for them to action.

We saw staff attended a hand over meeting twice a day. This was recorded on a wipe board in the office so staff could see the activities and what was important to people that day.

We reviewed the homes audit system for infection control and buildings maintenance. This audit was undertaken once a month. The audit failed to identify some areas of risk relating to infection control and buildings maintenance. We fed this back to the registered manager and owner. The provider might wish to note that this audit did not robustly identify some areas of infection control and buildings maintenance so that all concerns can be addressed.

The home had taken action to seek views from people and relatives by sending out recent satisfaction questionnaires.

There was detailed analysis of accidents and incidents and these were discussed in clinical meetings.

The provider had two managers who are registered with the Care Quality Commission at this location. They confirmed on our inspection that there is only one registered manager responsible for Victoria Court, we have asked the provider to contact the manager who had left their employ and ask them to de register for this location. The report will therefore still include the names of the two registered managers until we have received an application that the former manager has deregistered.

We have asked the provider to submit a new statement of purpose to reflect the management changes.

We were told the service was responsive, one person said 'they are pretty good and work around my needs.' We observed that staff explained and discussed with people their choices and any actions needed to support activity. For example, checking they had all they needed when going out.

We saw each person had a plan which described the support they required; in this we read people's choices were recorded and implemented. We saw there were risk assessments in place for some people which promoted well-being and prevented crisis.

Staff we spoke with were positive about working in the home and the contribution they made to people having fulfilling lives. We heard they felt well led and supported in their role by the home's management.

The environment was bright and communal areas were comfortably furnished. The home was in the process of being redecorated.

People were aware of the complaint system; this was provided in a format that met their needs.

We found people were not protected from the risk of infection because appropriate guidance had not been fully implemented.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

During our inspection we spoke with four of the six people who lived at the service. All of the people we spoke with told us that they liked living at the home and that the staff involved them in their care and support.

People told us they were encouraged to be independent and were involved in planning their activities and how they spent their time.

People were supported to establish and maintain relationships with their families and friends.

Care and support delivered by the home was tailored to people's individual needs.

We found that medicines were managed appropriately and safely at the home. Some people in the home were supported to manage their own medicines safely.

The staffing levels at the home were found to be appropriate for the needs of the people living at the home.

People were supported to make complaints and could be confident that these would be listened to and dealt with appropriately.