19 April 2023
During an inspection looking at part of the service
Victoria Grand is a residential care home providing accommodation and personal care for up to 26 people. The service provides support to older people, people with dementia and younger adults. At the time of our inspection there were 13 people using the service. The care home accommodates people in an adapted building over 3 floors, there is a lift to connect the floors.
People’s experience of using this service and what we found
There were not always enough suitable staff to provide safe and effective care to meet people’s needs, including at night-time and for social support.
Risks to people were not always identified, assessed or managed effectively. Some people needed support with mental health needs and expressing feelings of distress or agitation. Staff did not have clear guidance about the level of risk and strategies to provide care safely. Medicines were not always managed safely because some protocols lacked detail to ensure staff had the information they needed when they administered medicines. Environmental risks and infection prevention and control risks were not always identified and managed. This meant there were increased risks of avoidable harm to people.
People were spending the majority of their time in their rooms, and some reported feeling isolated, bored and lonely. A person said, “I can spend hours and hours on my own.” Another person told us, “I am in my room a lot of the time, in fact most of the time.” Organised activities happened for a few hours on 2 afternoons a week. People said they saw no point in leaving their rooms because there was nothing to do. Staff told us they were too busy to spend time with people.
Care was task focused and care plans did not always support a personalised and holistic approach. Some people had mental health needs, but records did not reflect the support they needed. Staff told us they knew people well and this mitigated risks to some extent, but the lack of personalised records meant the provider could not be assured that people were receiving the care they needed and new or unfamiliar staff did not have all the information and guidance to support people.
Systems for assessing the quality and safety of the service were not all effective and robust. Audits had been undertaken on a regular basis but did not always identify shortfalls to drive improvements. A lack of effective leadership and management systems, including contingency plans, were not robust and this meant safe staffing levels were not maintained.
Staff understood their responsibilities for safeguarding people. People told us they felt safe living at the home, and they described kind and caring staff. 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.
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 31 October 2018).
Why we inspected
The inspection was prompted in part due to concerns received about staffing and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.
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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report. Following this inspection, the provider confirmed that they had taken action to make improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria Grand on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to staffing, risk management, person-centred care which includes meeting people’s social needs, and leadership and management at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.