We carried out a review of the data available to us about Victoria House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Victoria House, you can give feedback on this service.
Victoria House is a residential care home providing accommodation and personal care for up to 47 people. The service provides support to older people, people living with dementia and people with a mental health diagnosis. At the time of our inspection there were 33 people using the service.
Victoria House has 6 separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia and another specialises in providing support for people living with a mental health condition.
People’s experience of using this service and what we found
People were protected from the risk of harm, felt safe, and staff were aware of how to raise any safeguarding concerns. Care and risk support plans set out people’s known risks and provided guidance to ensure staff could provide safe care. Some risk assessments did not contain enough detail, and this was rectified during the inspection. Medicines were managed safely. New staff were safely recruited and there were enough staff to meet people’s needs. The provider was working within current government guidance in relation to infection control and there were no restrictions upon visiting arrangements. Incidents and accidents were acted upon appropriately and lessons were learned when things went wrong.
Some improvements to the décor would be beneficial to support and stimulate people living with dementia, We have made a recommendation about the environment in the effective section of the report., the registered manager began to work on this during the inspection. People were assessed prior to moving into the service and were supported by staff with a good level of knowledge and skills. People received effective support with eating and drinking. People were supported to have control over their lives. Staff worked with other agencies, seeking advice and support when needed. The service made use of adaptive technology to support independence and reduce risk.
Mental capacity assessments were in place for people who lacked or had fluctuating capacity to make specific decisions, but these did not cover all key decisions. Staff knew about the Mental Capacity Act 2005 (MCA) and how to support people to make day to day choices about their care and routines. Staff supported people in the least restrictive way possible and in their best interests however these decisions were not always recorded, this raised the risk of decisions being made which did not always follow the principles of the MCA.
Systems in place to monitor the quality and standards of the service were not always effective. We found inconsistencies in records relating to allergy information, diabetes risk assessments and MCA assessments. There was a positive culture in the service. People said the registered manager was approachable and responsive. Staff received regular supervision and 1 to 1 meetings to support learning and development. The provider had clear policies and procedures in place to support staff. There was an ongoing improvement plan for the service. The provider ensured any lessons learned from incidents was shared across the service and region.
People were treated with respect and their dignity was upheld. People were involved in their care planning. We observed staff interacting with people in a friendly and supportive way. There was a positive approach to the delivery of people's care. Staff understood the people they were supporting and knew them well.
Care plans contained information about people’s preferences and people received care tailored to their needs and wishes. Activities were planned to enable people with a range of communication needs to be involved. There was easy read information available in the service. The provider responded appropriately to complaints and sought out regular feedback from staff, relatives and people using the service.
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 28 December 2018).
Why we inspected
The inspection was prompted in part due to concerns received about staffing in the service. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe section of this report.
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 Victoria House on our website at www.cqc.org.uk.
People continued to receive safe care. Staff had been provided with safeguarding training to enable them to recognise signs and symptoms of abuse and how to report them. There were detailed risk management plans in place to protect and promote people’s safety. Staffing numbers were sufficient to keep people safe and the registered provider followed thorough recruitment procedures to ensure staff employed were suitable for their role.
People’s medicines were managed safely and in line with best practice guidelines. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.
People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people. People received enough to eat and drink and were supported to use and access a variety of other services and social care professionals. People were supported to attend health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.
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. The principles of the Mental Capacity Act (MCA) were followed.
People continued to receive care from staff who were kind and caring. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences.
People’s needs were assessed and planned for with the involvement of the person and/or their relative where required. Staff promoted and respected people's cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.
The service continued to be well managed. People and staff were encouraged to provide feedback about the service and it was used to drive improvement. Staff felt well-supported and received supervision that gave them an opportunity to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.
More information is in the Detailed Findings below
Rating at last inspection: Good (report published 13/07/2016)
About the service: Victoria House is a purpose built single story care home that provides residential care for up to 47 older people, including people living with dementia.
Why we inspected: This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.
Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.
The service had 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.
At the last comprehensive inspection on 27 and 28 November and 20 December 2014 we asked the provider to take action to make improvements to the cleanliness and hygiene of the environment, meeting the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) and record keeping. We received a provider action plan that informed us of the date the provider said they would meet the relevant legal requirements. We carried out a focused follow up inspection on 16 July 2015 and found the actions by the provider had been completed. However we could not improve the rating for the three questions, is the service safe, effective and well led, from requires improvement. This was because to do so required consistent good practice over time. We checked the provider was continuing to meet the relevant requirements during this comprehensive inspection.
The staff understood what constituted abuse and the safeguarding procedures to follow to report abuse both internally and externally. People were supported to take risks and make informed choices. Medicines were appropriately managed.
Staff were recruited following safe and robust procedures and there were sufficient numbers of suitable staff available to meet people’s assessed needs. Staff received training to ensure they were equipped with the skills and knowledge to support people using the service. Staff supervision systems were in place to ensure they had the opportunity to reflect on their work practice and plan their learning and development needs.
People’s consent was sought before staff provided their care. People who lacked capacity to make decisions were supported following the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).
People had a balanced and varied diet and their dietary needs were assessed and monitored. They had regular access to healthcare professionals and were supported to attend health appointments to ensure their health and well-being was maintained
Staff treated people with kindness, compassion, dignity and respect. Independence was promoted and people were enabled to make and maintain relationships.
Individualised care plans were in place that reflected people’s needs and choices on how they wanted their care and support to be provided.
The service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and companionship.
People and their representatives were encouraged to provide feedback on the service and suitable arrangements were in place to respond to any complaints.
The vision and values of the service were person-centred. People and their representatives were supported to be involved and in control of their care.
Quality assurance management systems were in place to monitor the safety of the environment and the quality of the service.
Victoria House is a residential care home that provides personal care and accommodation for up to 47 older people including people living with dementia.
The service 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.
At the last comprehensive inspection on 28 November and 29 December 2014, we identified the following areas where the provider was required to take action to make improvements.
The registered person had failed to have suitable arrangements in place for obtaining and acting in accordance with the consent of people in relation to the care and support provided for them in accordance with the Mental Capacity Act [MCA] 2005 and the Deprivation of Liberty Safeguards [DoLS]. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
The registered person had failed to ensure that appropriate standards of cleanliness and hygiene were maintained. This was because equipment was not appropriately cleaned; floor coverings were heavily soiled and had an odour. Clean linen was stored on the floor in the linen cupboard. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
The registered person had failed to ensure that accurate records were maintained for people. This was because food and fluid records were not appropriately maintained. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Following the inspection the provider sent us an action plan detailing the improvements they were going to make to meet the relevant legal requirements, and stated the improvements would be achieved by 31 May 2015.
This report only covers our findings in relation to the areas checked during the focused inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Victoria House on our website at www.cqc.org.uk
This focused inspection took place on the 16 July 2015 and was unannounced. The purpose of the inspection was to check that the provider had followed their action plan to meet the legal requirements and found the actions had been completed.
People were involved in planning their care, their choices and consent was sought by staff before they carried out their care.
People’s care plans contained assessments of their mental capacity to make informed decisions and where people lacked the capacity to make some decisions ‘best interest’ decisions were made on the person’s behalf following the Mental Capacity Act and Deprivation of Liberty codes of practice.
The home was clean and tidy and free from unpleasant odours.
Regular management audits were carried out and used to continually drive improvements and appropriate records were maintained.
While improvements had been made we have not revised the rating for these key questions; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice. We will review our rating for safe,effective and well-led at the next comprehensive inspection.
The inspection was unannounced and took place on 27 and 28 November 2014. We visited again on 29 December 2014 to complete the inspection.
Victoria House provides personal care and accommodation for up to 47 older people with frail elderly care needs, who may also be living with dementia. On the day of our visit, there were 41 people living at the service.
The service 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 and associated Regulations about how the service is run.
At our previous inspection in June 2014, we found that people's care plans did not always contain sufficient detail to guide staff as to the care that people required. This meant that the care they received was not always reflective of their current needs. We also found that appropriate arrangements were not in place to ensure that medicines were administered safely. Various records could not always be located as and when they were required. The provider did not consistently use quality assurance processes regularly to assess and monitor the quality of service that people received. Following this inspection, the provider sent us an action plan to tell us the improvements they were going to make by October 2014.
During this inspection, we found that although some improvements had been made, it was evident that further improvements were still required to meet essential standards of care.
We found that appropriate standards of cleanliness and hygiene of the environment and equipment were not maintained within the home. You can see what action we told the provider to take at the back of the full version of the report.
Some people were not able to move in and out of the service freely, as the unit door was kept locked. People’s liberty was being deprived. There was no evidence that the provider had submitted Deprivation of Liberty Safeguards [DoLS] applications to the statutory body to deprive people of their liberty in their best interest. You can see what action we told the provider to take at the back of the full version of the report.
People’s food and fluid balance records were not appropriately maintained, there were lengthy gaps where there was no record of fluid being offered. You can see what action we told the provider to take at the back of the full version of the report.
Staff were knowledgeable about the risks of abuse and reporting procedures. On the day of our inspection there were sufficient staff available to meet people’s care and support needs. Safe and effective recruitment practices were followed. Some improvements had been made to ensure that people’s medicines were administered safely.
We found that people’s dietary needs were known to staff. People had access to the GP and healthcare specialists when required. People told us that staff treated them well and promoted their privacy and dignity.
People’s needs were assessed prior to coming to live at the home but they were not consistently involved in the review of their care needs. People said that they knew how to make a complaint and were confident if they made one it would be addressed appropriately.
We found the provider had systems for monitoring quality through a range of audits; however, actions from audits undertaken were not always addressed.
Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.
If you want to see the evidence supporting our summary please read the full report.
Is the service safe?
Staff demonstrated an understanding of the support required to enable people with dementia to make choices about their daily care. The registered manager had recently been informed that the pharmacy, which supplied people with their medicines and staff with an electronic medicine recording system, had ceased trading. The registered manager and staff took swift action to ensure people living at the home continued to receive a supply of medicine in a safe way. However, we found that there were several medication errors during our inspection visit and this put people at risk of developing a health related condition. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.
People received an assessment of their needs in order to identify any areas of risk in delivering their care. Staff reviewed most people's risk assessments to ensure any changes to people's health and well-being were identified promptly. However, we found that some people at high risk of developing health conditions did not always receive care as indicated in their care plan records. People did not always receive a re-assessment of their needs following a stay in hospital to ensure their care needs could be met by the service. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.
Is the service effective?
People's health and care needs were assessed with them, and they and their family members were involved in writing their plans of care. There was a system of staff training and supervision in place to ensure staff were sufficiently supported to do their jobs.
People and their relatives told us that overall they were happy with the level of care provided. We observed people were relaxed and happy in their environment. We observed some people enjoyed the company of other people in the living areas. One person said 'There are a range of activities here, and we have bingo, scrabble, cards and people come to sing to us'. They told us that they enjoyed a wide range of activities on offer at the home. We observed that people had access to a well maintained and safe garden and they were observed sitting in the garden and enjoying the good weather.
People's records including monitoring charts for food and fluids, re-positioning charts and medication administration records (MAR) were not always stored appropriately. This made it difficult to find information to ensure people had received good care. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.
Is the service caring?
People were supported by kind and attentive staff. We saw that care staff showed patience and gave encouragement when supporting people. People told us that they were happy living at Victoria House. One person said 'I like it here, I have a comfortable bed and my bathroom is clean'. They also told us 'There is a beautiful garden, and the staff are nice, they help me to get dressed and are really caring people'.
The home had two resident cats and we observed that this helped to create a homely environment which people enjoyed. One person said 'I love the cats; it's more like being at home'. A relative of a person who used the service told us that they were 'impressed' with their family member's care and they had been encouraged by staff to come and join their family member for lunch, which they had enjoyed.
Is the service responsive?
Staff had responded appropriately to a range of medical needs and we saw that medical professionals such as the G.P, district nurse and dietician were regularly involved in people's care. We also observed staff working in the kitchen area and saw that they prepared fresh meals and a range of desserts for people using the service. Staff told us that they catered for a range of diverse needs and this included having a 'kosher' menu for people of Jewish origin.
We observed people who were seated in a communal living area during the afternoon of our visit were assisted by staff, and provided with sufficient amounts of refreshments such as tea, coffee, soft drinks sandwiches and cakes.
Is the service well-led?
The service had a quality assurance system to gain regular feedback from people who used services and to monitor the quality of service provided. However, we found that some identified improvements were not always acted upon. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.
The service worked well with other agencies and services to make sure people received their care in a joined up way. Staff stated that the registered manager expected high standards of care at the service. However, a few staff told us that the registered manager did not always walk around the home to spot check the quality of service delivered.
We looked at care records for seven people. We found that one person had very limited care plans. The care plans for the other six people contained the basic information staff needed to meet people's care needs. We looked at a selection of monitoring charts which showed that care was not always being delivered as specified in people's care plans.
We found that the temperature of the medication storage rooms had been recorded as being outside the recommended range on several occasions during the previous two months. We found that medication records did not account for all medication in stock or administered.
We spoke with five people who all told us they were happy with their care and spoke highly of the staff. People told us that they did not have to wait when they needed assistance from staff.
We saw that there was a system in place to identify, assess and manage risks to the health, safety and welfare of people using the service and others but it was not always effective.
In the main we observed staff showing genuine, warmth, care and affection towards people they were caring for. Generally the staff worked at a relaxed pace, helping to create a relaxed atmosphere. People were encouraged to have a sense of belonging, and helped to do things for themselves.
We also observed ways in which staff did not show respect for people, although this was not seen as being done through any malicious intent but more through lack of self awareness and training.
It is important in good dementia care to be aware of the environment and how this can affect the process of communicating with people with dementia. Throughout the whole of the time spent in the communal lounge music was playing on a CD player at one end of the room and the TV was on at the other end of the room. People within the room did not appear to be enjoying either of these.