Archived: Victoria Lodge

Victoria Lodge is registered to provide accommodation and personal care to a maximum of 63 older people who may have a diagnosis of Dementia. At the time of the inspection there were 59 people living at the home.

There was a registered manager at the home. 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 told us they felt there were not enough staff to meet their needs and that they had an extended wait when support was needed. However, we observed that there were sufficient numbers of staff available. We saw that staff had undergone appropriate recruitment processes to ensure they were safe to work and had access to ongoing training and supervision to support them in their role.

We saw that staff had received training in how to give medication and were observed doing this by the registered manager to ensure they remained competent in this. However, we found there were errors in the recording of medication given that meant the provider was unable to evidence these medications had been given as prescribed.

People were given choices by staff and had their rights upheld in line with the Mental Capacity Act 2005. Where people lacked capacity to make decisions, best interests meetings were held to ensure their rights were maintained.

We saw that choices were given at mealtimes but people had expressed that they were not always satisfied with the meals made available to them. We saw that the registered manager was taking action to improve the quality of food.

Staff had a kind and caring approach. People told us they were treated with dignity and we saw that people had access to advocacy services when required. Staff had a good understanding of people’s needs and knew their preferences with regards to their care.

People were aware of how to make complaints. We saw that no complaints had been made but the registered manager could explain how any complaints would be managed.

Systems were in place to monitor the quality of the service. Where areas for improvement were identified, these were acted upon by the registered manager. We saw that people and their relatives were given opportunity to feedback on the service they were provided with and that suggestions made were implemented.

We checked to see that people's health and well-being was being promoted by the care home.

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with six people using the service, eight visiting relatives, nine members of staff, a visiting healthcare professional, the acting manager and area manager. We also looked at six records relating to people's care and other records related to the running of the service.

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

Is the service safe?

Some people told us they felt safe at the home although we saw that there were occasions where we saw people looked anxious, angry or nervous due to the challenges presented to staff by one person. We saw staff did not always know how to respond and as a result people may not have felt safe.

The provider informed us that they have responded by providing one to one staffing since our inspection, although they were aware of this risk prior to our raising it as a concern at the inspection.

People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards (DoLS). We heard that two people had a DoLS in place and staff were aware why they were in place and what restrictions they authorised. We saw that the conditions of the DoLS were met with the exception of provision of a specific type of training for staff. The absence of this training presents a potential risk to people as some staff may not be aware of how to approach people in the least restrictive way.

The service was clean, safe and hygienic and people told us that the environment was clean. One relative told us, 'This place is immaculate'.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

Is the service effective?

People's health and care needs were not always assessed with them, but we heard people's involvement in their care plans had improved. Some people were not aware of what was in their care plans but most people felt the care they received was as they wished it to be. We saw care plans had been reviewed regularly and were able to provide staff with the knowledge to meet people's needs.

We heard from people, and saw that meals were appetising and there was a choice available. Specialist dietary needs were assessed although the support people were given with their meals did not always reflect their needs, and we saw some people were not supported or encouraged at meals times meaning they did not eat. We were also not assured that people were consistently supported to have sufficient fluids.

Visitors we spoke with confirmed that they were able to see people in private and that visiting times were flexible. One relative told us that, 'Visiting welcomed, wonderful'.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey and were involved in meetings. There were some shortfalls, and concerns had been raised by relatives. We saw that some of these concerns had been responded to although there was some that had not. This meant that people and their representatives were at risk of not having their concerns properly taken into account.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people at risk of malnutrition or dehydration receive sufficient food and fluids.

Is the service caring?

We saw that people were at times supported by kind and attentive staff. We saw some care workers showed patience and gave encouragement when supporting people. One relative told us, 'Staff are lovely with residents'. We also saw other occasions where people's dignity was not promoted, and one person told us they liked their bedroom door shut, but staff left it open compromising their privacy.

We asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring people's dignity and privacy is respected, and people's views are consistently responded to.

Is the service responsive?

We looked at the last admission to the home from another service and we found there was a lack of robust assessment prior to their readmission. As a result we found the person's care plan was not up to date although staff were aware of these and the person confirmed these were met.

We heard from people, relatives and staff that care was not always responsive due to the insufficient availability of staff. We saw occasions where there was a slow response to people's needs. One relative told us,' The staff are so rushed. They are struggling'. Staff we spoke with told us their availability impacted on their response to people's needs. One member of staff told us, 'Today we didn't get everyone up until 12.30pm. Some people were left waiting a long time to get up'. This meant that staff responses to people's needs may be delayed and their choices compromised.

We have asked the provider to tell us what improvements that will make in relation to improving staffing levels and/or staff deployment.

Is the service well-led?

This report states Mrs R Skelton is the registered manager. They were not managing regulatory activities at this location at the time of the inspection. Their names appear because they were still identified as registered manager on our register at the time.

We heard from some relatives that the managers had responded to some concerns they had raised and one told us, 'The new manager is lovely, I can't speak highly enough of her'.

Staff we spoke with were aware of who to report their concerns to and knew how to whistle blow.

The service has a quality assurance system but records seen by us showed that not all of the shortfalls identified had been addressed. Staff told us their views were not listened to, for example one told us, 'I keep reporting things but nobody cares, the hoist keeps losing charge and we have few wheelchairs now'. Another told us, 'I'm so stressed there is no organisation, the managers never come out'. The manager told us they were looking to talk to staff individually but the lack of confidence staff expressed in management meant that staff told us they did not feel able to provide feedback, so their views may not be properly taken into account.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to quality assurance, and the improvements they will make in relation to supporting staff appropriately, so as to improve their morale.

We spoke with 10 people who lived at the home and six relatives. We observed how care was provided to people and looked at six people's records. We spoke with five members of staff, the manager and a senior manager. We looked at other records related to the management of the home.

We saw that people were provided with care and treatment as recorded in their care plans. One person said, 'Pretty decent here when there is enough staff'.

Some people told us that they had a choice of meals and were happy with the meals. Others said 'There's no real choice of food'. We saw that some people were well supported with their meals. Records did not always show they had sufficient fluids.

We saw that new staff members were vetted to ensure they were safe to work with vulnerable adults.

People we spoke with expressed satisfaction with the care and treatment they received although they were concerned that there was not always sufficient members of staff to respond to their needs quickly.

There were systems in place to monitor the quality of the service, although we identified some potential areas of risk that had not been identified. A visitor said, 'We see some good work and then it slips back'.

People told us that, 'I have the best carers in the world'. Visiting relatives we spoke with told us, 'There's no bad thing about it (the home)' and people, 'Get care that is needed'. We saw positive relationships between people and staff when they were providing support. People received appropriate support with staff showing patience and offering verbal encouragement. People received support that reflected their records. People's health care was promoted.

We found that staff's understanding as to how to protect people and report abuse had improved.

We found that systems for the management of medication had improved. This meant that people were better protected against the risks associated with medicines.

Staff showed they understood people's needs. Staffing levels and deployment had improved with the result that people's needs were met and people were safer. Staff had been provided with additional training although there was still room for some improvement in staff training levels. The manager had recognised this and a programme of training and retraining was in place.

The ways in which feedback from people and their representatives was obtained had improved. Better outcomes for people showed that monitoring of quality had improved.