Archived: Victoria Care Home

Victoria Care Home is a residential care home registered to provide personal and nursing care for up to 53 people. The home supports people aged 65 and over, some of whom were living with dementia. The home is divided into 2 units with 1 unit on the ground floor and 1 unit on the first floor. At the time of this inspection 44 people were living at the service.

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

People received safe and effective care that met their needs and respected their choices and personal preferences. All the people and their visiting relatives and friends spoken with during the inspection praised the staff, the management team and the standard of care provided.

There were sufficient suitably qualified, trained, and experienced staff on duty and safe recruitment procedures were followed.

Risks to health, safety and welfare of people who lived, worked and visited the home were identified and managed safely.

Medicines were received, stored, administered, recorded and disposed of safely.

Safeguarding systems, policies and procedures ensured people were safe and protected from abuse.

Safe infection prevention and control practices were followed to minimise the spread of infection, including those related to COVID-19.

Staff presented as well trained, caring professionals who had developed positive relationships with the people who lived at and visited the home. They were pleasant, engaging and showed skill and sensitivity in the way they responded to 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.

Managers and staff were clear about their roles and responsibilities, and promoted a positive, person-centred culture. They worked well together as an effective team and had good relationships with other care professionals. This ensured that people received joined up health care and their needs were met.

Effective systems were in place for checking on the quality and safety of the service and making improvements where needed.

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 22 July 2021) and there were breaches 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.

Why we inspected

Our routine monitoring identified that the service had improved significantly on safe and leadership and governance previously rated as requires improvement. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Please see the safe 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. 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 improved from Requires Improvement to Good. This is based on the finding from 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 Victoria Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Victoria Care Home is a residential care home registered to provide personal and nursing care for up to 53. The home supports people aged 65 and over, some of whom were living with dementia. The home is divided into two units with one unit on the ground floor and one unit on the first floor. At the time of this inspection 41 people were living at the service.

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

Systems in place to monitor the quality of the service were not effectively implemented and failed to highlight or address concerns identified during this inspection. Improvements were needed to ensure the service is safe and well-led.

The care planning and recording systems in place were not fully utilised and did not ensure that up to date information was available in relation to people's needs being planned for or met. Improvements were needed to ensure that people's medicines were safely managed and the process to be followed for referring incidents under agreed safeguarding procedures.

People were supported by sufficient staff so that their needs and wishes could be met.

People were supported by staff who had access to and received training in relation to Health and Safety and Safeguarding.

The provider had identified areas of improvement needed at the service and was in the process of implementing an action plan to make the improvements.

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 21 December 2019).

Why we inspected

This inspection was planned in response to receiving information about incidents and falls that had recently occurred within the service.

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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

During the inspection the provider took action to mitigate identified risks.

The overall rating for the service has changed from Good to 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 Care Home on our website at www.cqc.org.uk.

We found the following examples of good practice:

• Staff did not move between the ground and first floor units to minimise the risk of transmission.

• There were designated personal protective equipment (PPE) donning and doffing areas at the home. Staff donned and doffed PPE in line with guidance and staff were wearing PPE correctly during the inspection.

• Clinical waste was managed safely and in line with the national guidance. Staff also carried out additional cleaning in the areas through which clinical waste was removed from the building.

• The home had a regular testing programme in place. New staff were tested before they started to work at the home to ensure they did not have COVID-19.

• Cleaning schedules at the home had been reviewed and enhanced. This included regular cleaning of frequently touched surfaces throughout the day.

Further information is in the detailed findings below.

Victoria Care Home is a residential care home providing personal and nursing care to 44 people aged 65 and over at the time of the inspection. The service is registered to support up to 53 people.

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

People told us they felt safe living at the home and there were systems in place to safeguard them from abuse. One person said, “I just feel safe, everybody is nice.” People felt staffing levels at the home were good and staff came quickly when they needed help. During our inspection we saw call bells and people asking for help were attended to promptly.

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.

People told us they enjoyed the food and drink at the home and we saw they had regular and easy-access to drinks and snacks throughout the day. We also observed staff were supportive and encouraging with people and where needed gave them assistance to eat and drink. People and their relatives said staff at the home were good at helping them to access other healthcare services when needed and staff obtained and appropriately followed advice from other healthcare professionals.

People and their relatives gave us positive feedback about the quality of care at the home and staff approach. We observed many caring interactions throughout our inspection. One person said, “I love it here it would break my heart if I had to live anywhere else, [the staff] are kind to me and make me very comfortable, I absolutely love it here I'm so well looked after.”

People’s care plans gave staff the information needed to support people safely and effectively. People said there was lots to do at the home and they enjoyed the activities on offer. Staff also tried to prevent social isolation by spending time talking with people as much as possible.

There was a caring culture amongst staff at the home and there were systems in place to monitor the safety and quality of service being provided. People and their relatives told us senior staff at the home were approachable.

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 5 April 2018).

Why we inspected

The inspection was prompted in part due to concerns received about people not getting enough to drink leading to a deterioration in their health, poor record keeping relating to people’s fluid intake and a lack of appropriate seating in communal areas. 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.

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.

Victoria Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Victoria Care Home accommodates up to 53 people in one purpose built building divided in to two units. The ground floor accommodates people that require nursing care. The first floor specialises in providing care to people living with dementia and related conditions. On the day of the inspection 45 people were living at the home. There are 46 single rooms and six double rooms. It is situated in Rainford, St.Helens.

The service has 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 inspection on 6 October 2016 we found that there were a number of improvements needed in relation to safe care and treatment, privacy and dignity and good governance. These were breaches of Regulation 10, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Effective, Caring and Well-led to at least good. The provider sent us an action plan that specified how they would meet the requirements of the identified breaches. During this inspection we found all the required improvements had been made.

This inspection was done to check that improvements had been made to meet the legal requirements planned by the registered provider after our comprehensive inspection on 6 October 2016. The team of two inspectors and an expert by experience inspected the service against all of the five questions we ask about services: Is the service Safe, Effective, Caring, Responsive and Well Led? We found that the registered provider was meeting all of the legal requirements.

Improvements had been made that related to people being treated with dignity and respect by staff. We observed people being treated with dignity and their privacy was respected. Many positive interactions between staff and people living at the home were observed throughout the inspection visit.

Improvements had been made to people's dining experience. People spoke positively about the food and told us they were always offered choices of food and drink. We observed the dining room experience and found it to be positive. Staff demonstrated good interaction and offered appropriate support when required.

Improvements had been made with the consistent completion of records that related to people's safe care and treatment. People that required regular well-being checks, repositioning and nutrition and hydration monitoring had records in place that were fully completed.

Improvements had been made to the governance systems undertaken by the registered provider at the home. Regular audits were undertaken and areas for development and improvement were identified and actioned.

Safe and robust recruitment practices were in place and sufficient staff were employed to meet the assessed needs of the people living at the home. All staff had undertaken a comprehensive induction and completed the mandatory training required for their roles. Supervision and appraisals took place regularly. Staff attended team meeting and shift handovers.

People were assessed before they moved in to the home and this information was used to produce detailed risk assessments and person centred care plans. People's choices were included and their independence was promoted where possible. All documents were reviewed regularly and amendments made if there were any changes to people's needs.

People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process.

People had access to a variety of activities of their choice. The management team had developed relationships with local community organisations.

The registered provider had clear safeguarding policies and procedures in place. Staff had received up to date safeguarding training and were clear about the procedures they would need to follow if they had to raise any concerns.

Medication policies and procedures were in place. Staff that administered medicines had all completed training and had their competency assessed. Medicines ordering, storage, administration and disposal were all managed in accordance with best practice guidelines.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA). Records showed that consent was always sought in relation to care and treatment.

Victoria Care home was well maintained and all equipment was regularly serviced. All required health and safety checks and documentation were in place as well as fire safety equipment checks.

The registered provider had a clear complaints policy and people knew how to raise any concerns.

We previously carried out an unannounced comprehensive inspection of this service on 30 June 2016. After that inspection we received concerns in relation to people experiencing weight loss while living at the service. Concerns were also raised regarding the communication between staff and people living with dementia. As a result we undertook a focused inspection to look into these concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Victoria Care Home on our website at www.cqc.org.uk”

The service had an overall rating of good at the last inspection, however the ‘well led’ domain was rated as requires improvement.

Victoria Care Home is located in the village of Rainford, St. Helens, providing nursing care and support for up to 53 residents. The service which is part of the Four Seasons Health Care Group, is a modern, purpose built facility with 46 single bedrooms, and six double bedrooms, set over two floors. The ground floor, Alexander unit accommodates people who require nursing care. The Edward unit on the first floor, accommodates people who require care and support with dementia and related conditions.

A registered manager was in post; however was on extended leave until January 2017. A temporary manager was in post to cover the period of absence. 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.

During this inspection on 6 October 2016 we found breaches of the Health and Social care Act 2008 (Regulated Activities) 2014.

During the mealtime experience upstairs we found people were not offered choice from the menu. Two people were being fed at the same time by one member of staff who offered very little positive interaction whilst carrying out this task. People told us they did not enjoy the meals. People were not offered a choice of sandwich fillings, were not told the flavour of the soup or asked whether they would like white or brown bread. The mealtime experience was not managed in a way that promoted a pleasant dining experience for people, while maximising their choice and control. People's perception and understanding of how to access food and drink was influenced by their level of independence.

We found essential records for the monitoring of nutrition and hydration were not fully completed which meant that staff could not be sure people had eaten enough food or drank enough fluids. This left people at risk of dehydration and malnutrition.

Staff on the first floor consistently demonstrated poor communication skills. For example people would ask a direct question and not receive a response. During times when people were in receipt of support to eat and drink, staff did not communicate with them at all. People and visitors that were able to share their experience stated staff were not always caring and support was variable.

The registered provider did not have robust auditing processes to highlight areas for development and improvement. We found systems that were in place were ineffective as they had failed to identify gaps within the record keeping procedures.

You will see what action we told the registered provider to take at the back of the full version of the report.

Visitors to the service and people living on the ground floor of the service reflected positively about staff and stated they were kind and caring.

Staff were up to date with the training required to undertake their roles and received regular supervision.

Victoria Care Home is located in the village of Rainford, St Helens, providing nursing care and support for up to 53 residents. The service which is part of the Four Seasons Health Care group, is a modern, purpose built facility, with 46 single bedrooms, and six double bedrooms, set over two floors. The ground floor, Alexander unit accommodates people who require nursing care. The Edward unit on the upper floor, accommodates people requiring care and support with dementia and related conditions. At the time of this inspection 51 people were living at the service.

A registered manager was 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 inspections in July and December 2013 we found that the service was meeting all of the regulations that we assessed.

We have made a recommendation that the registered provider considers best practice for use of people’s chairs is considered under the Mental Capacity Act 2005 to ensure that individual’s best interests are considered at all times. Where appropriate people assessed and not having the mental capacity to make specific decisions had supported under the Mental Capacity Act 2005. Staff had received training in the Mental Capacity Act 2005 and demonstrated an awareness of the basis principles of the Act.

We have made a recommendation that registered provider reviews their procedures in relation to reporting significant events to ensure that the appropriate regulations are met. Not all of the notification required had been sent to the Care Quality Commission.

Procedures were in place to protect people from abuse and people told us that they felt safe living at the service. All staff had received training in safeguarding vulnerable people.

People’s medicines were stored appropriately and systems were in place to ensure that people received these when they needed them.

Sufficient staff were on duty to meet the needs of people. Effective recruitment procedures were in place to minimise the risk of people not suitable to work with vulnerable people being employed.

Risks to people’s health, safety and wellbeing were assessed and plans had been put in place help ensure that they received the care and support they required.

People’s dietary needs were planned for and when required, monitored to ensure that people had sufficient amounts to eat and drink.

People were supported by a staff team who received regular supervision, training and support for their role. This meant that the staff team had up to date knowledge of current best practice.

A complaints procedure was in place and people were confident that any concerns they raised would be listened to.

The registered provider had several systems in place to gather people’s views on the service they received. This helped ensure that people were able to comment on the standards of care and support they required on a regular basis.

Regular audits took place around the service to ensure that the environment was safe and people’s care planning documents and medicines were kept up to date.

We looked in detail at three peoples care records and found they were up to date and accurate. Important information such as daily records of care, assessments and care planning were detailed and had been reviewed by the nursing and care staff.

Prior to the inspection we were sent evidence to show that the care records are regularly audited by senior managers to help ensure consistent standards.

People experienced care, treatment and support that met their needs and protected their rights. One person told us, 'I think Mum has a key worker but you can go to anyone as they all seem to know all about her and what is happening. Take today, the new manager let us in and could tell us mum had two ice creams yesterday.'

The provider had an effective system to regularly assess and monitor the quality of service that people receive. All of the people we spoke with said they had no worries or concerns, but that they could talk to staff if they had any.

Records available in the service were not always kept securely and did not contain information that was accurate and up to date. Clear records support staff to provide efficient, consistent and effective care that meets people's individual needs.

We spent time in the lounge area on the ground floor, observing staff interacting with people. We noted that staff were respectful yet friendly towards people, explaining any intervention. We asked one person about their life at the home; they told us

"I like it here very much. I'm never told what to do, I'm asked what I'd like to do." Another person told us how they had liked a particular light fitting in the home, and requested one for their own bedroom, which was provided. They had also chosen wallpaper for their bedroom, and a picture for a communal lounge.

We spoke to staff on duty at the home. One nurse told us "I am happy here, I've got a good team around me, and many of them have been here for years. There is a good team spirit, it works."

A relative was able to spend time explaining to us, how the home had accommodated both their parents at short notice, and how relieved they had been to find a facility where their parents could stay together as a couple. They said " I can't explain how relieved I am; Mum has put on weight since being here. The staff have gone above and beyond to care for them. I leave here knowing they are happy and well cared for, and that gives me so much peace of mind."