Victoria Grand

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them. Care plans provided detailed information and guidance for staff and included people’s particular communication needs. For example, people living with dementia required staff to communicate clearly and patiently, staff to give people time to understand and digest the information and accede to their wishes and preferences.

The registered manager explained the process before people came to live at the home. They told us, “We get a referral through. I review it to see if we can support this person and I meet them face to face. It’s usually in hospital and I can look at their care plan. We talk with nurses and relatives and complete a full assessment. Risk assessments and a support plan is prepared before the person comes in, we agree an admission date and liaise with families. We see the person has everything they need and when they arrive, make them welcome.”

A relative told us they had not seen their family member’s care plan, but were asked lots of questions about their mum’s care, preferences and history. We saw people were consistently asked about their preferences, such as whether they wanted a hot drink, whether they wanted to sit in the lounge, or join in a particular activity.

Social workers who happened to be visiting the home at the time we were there explained their continued review of a person’s care and support needs, and felt the home were meeting their needs well.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

The registered manager met with people and their relatives to discuss their care and support needs, including their wishes and preferences. Care plans were reviewed monthly or when people’s needs changed. Staff also provided input as they knew people well. One staff member said, “We could not meet 1 person’s needs, so they moved somewhere else.” The home had worked with healthcare professionals to ensure this person was moved to an alternative setting where they could receive different support to meet their changing care and mental health needs in line with the requirements of the Mental Health Act 2007.

Medicines were not used to restrain people or control behaviour. Some people were prescribed anti-psychotic medicine which helped to regulate their mood, behaviours and thoughts. These were used appropriately and in line with the manufacturer’s recommendations.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff had access to the information they needed to support people appropriately. Care plans were detailed and informative, providing guidance for staff. Emergency care plans were printed out, including a medication profile, if people needed to go into hospital. Recommended Summary Plan(s) for Emergency Care and Treatment (ReSPECT) had been completed and provided personalised recommendations for people in emergency situations where they were not able to make decisions or express their wishes. The home worked with people’s GPs and their families to ensure people’s wishes and needs were met. Social workers reviewed people’s ongoing care and support needs following a respite stay, for example, when people were discharged from hospital.

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. Throughout the time of our inspection visit, we observed people did not always have drinks readily available; this put them at risk of dehydration. For example, 1 person had two empty beakers on the table in front of them, and a water jug was out of their reach. This remained the case throughout the morning. We reviewed this person’s fluid intake for January. Information within the records was inconsistent and inaccurate. On the first day of inspection, this person’s fluid monitoring showed they received drinks throughout the morning, but this was not the case. The person had developed a health condition that could be attributed to a dry mouth where yeast and bacteria can grow unchecked and had been prescribed a medicine for this. We saw that 2 other people did not have drinks readily available, with water jugs on the other side of the room out of their reach. People who came into the lounge were offered drinks by staff, but some people who stayed in their bedrooms, and were not independently mobile, were at potential risk of dehydration. People told us there was always plenty to eat and felt the meals offered choice and were of good quality. People’s dietary preferences and allergies were recorded. No-one required a modified diet, but the cook was aware of guidance under the International Dysphagia Diet Standardisation Initiative (IDDSI) should this be needed. People had access to healthcare professionals. A healthcare visit took place every Monday, attended usually by a nurse practitioner. Staff told us if they had any concerns about people’s health, then they could call the surgery, and at weekends, staff called a different number to receive healthcare advice and support.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensure that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Each person was allocated a keyworker. Keyworkers liaised with people and their families, and this ensured people had toiletries, appropriate clothing, and their belongings were looked after safely. Keyworkers spent 1:1 time with people, built rapport, and got to know people’s likes, dislikes and preferences; this information was shared with other staff to provide holistic care.

All staff were responsible for monitoring people to make sure their needs were met and also to look out for signs if people were unwell or changes in behaviour. Routine monitoring included taking people’s blood pressure, measuring oxygen levels and temperature. This ensured people remained well or, if there were concerns, actions could be taken.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

People’s capacity to make specific decisions had been assessed. Where people lacked capacity, application had been made under Deprivation of Liberty Safeguards (DoLS) and authorised by the local authority. Some people had conditions attached to their DoLS. For example, 1 person needed to have their medicines regularly reviewed in relation to their mental health; this was done. Where people required decisions to be taken in their best interests, multi-disciplinary meetings were arranged and outcomes recorded. Some relatives had Lasting Power of Attorney for finances and property, and health and welfare. These documents were scanned and kept in people’s care records.

Whilst staff understood the importance of protecting people’s privacy and security of personal data under the General Data Protection Regulation (GDPR), this was not always put into practice. We were able to access photos taken of people involved in various activities through social media; there were no security settings in place. We discussed this concern with the registered manager who provided reassurance that social media relating to people, staff and the home could only be accessed by people who had the right to do so, such as relatives.