Victoria House (Wallasey)

We found the following examples of good practice.

There was a programme of regular COVID-19 testing for both people living in the home, staff, essential carers and visitors to the home. Screening procedures included temperature checks and a negative lateral flow test.

Staff used personal protective equipment (PPE) and followed guidance and practices. There was ample PPE available to staff.

There was separate visiting pod that could be accessed outside the main building reducing the risk of infection visitors and people living at the home.

Victoria House is a residential care home providing personal care to 50 people aged 65 and over at the time of the inspection. The service can support up to 56 people.

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

At the last inspection, the provider was in breach of a number of regulations. This inspection reviewed three of these regulations to establish whether improvements had been made.

Although improved systems were in place to monitor the quality and safety of the service, systems didn’t always identify all the issues we found to ensure there was sufficient oversight and evaluation of risk to people. This is a continued breach of regulation 17 (Good Governance).

The management of medication had improved. Storage was robust and appropriate systems were in place to manage controlled drugs. Further development was needed strengthen the guidance available to staff in relation to ‘as required’ medicines. We have made a recommendation about this.

The provider had addressed the issues identified in previous inspections in relation to infection control and environmental safety. Additional and improved shower facilities had been installed as well as new sluice facilities. The garden area was secure and the smoking room had been made safe. Additional smoking facilities were available outside of the building.

Systems to investigate accident and incidents had improved and these were being regularly reviewed to learn from these events to prevent them from happening again in the future. Where the provider was required to report accidents and incidents to CQC, we found these records were complete and well maintained.

Staff members employed at the service were recruited safely. The number of staff on duty was sufficient to meet people's needs. Staff had received sufficient training and support and knew how to safeguard people from the risk of abuse.

Improvements had been made to ensure legal requirements were followed where a person was unable to consent to their care. 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 now supported this practice.

People received enough to eat and drink and health needs were being met. There were a range health and social professionals involved in people's care.

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 inadequate (published 16 October 2019) and there were multiple 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 some improvements had been made, however the provider was still in breach of regulations.

This service has been in Special Measures since 16 October 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 20 August 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, need for consent, privacy and dignity, person centred care and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements in relation to safe care and treatment, needs for consent and good governance. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from inadequate 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 House (Wallasey) on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified a continued breach in relation to governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Victoria House (Wallasey) is a care home that provides accommodation for up to 56 people who need help with their personal care. At the time of the inspection 50 people lived in the home.

People's experience of using this service

At the last inspection, the provider was in breach of regulations 11, 17 and 18. People’s consent was not always appropriately obtained and there was a lack of good governance and staff training. At this inspection, the provider had taken sufficient action with regards to regulation 18 (staff training) but remained in breach of regulations 11 (Need for Consent) and 17 (Good Governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Additional breaches of regulations 9 (person centred care) and 10 (privacy and dignity) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4) were also identified.

During the inspection, the manager did not demonstrate that they were of the concerns we identified. They did not demonstrate they understood their regulatory and legal requirements with regard to the service. In addition the provider failed to have sufficient oversight of the service’s management.

There were no adequate or effective systems in place to monitor the quality and safety of the service. This resulted in people being exposed to ongoing risks. For example, the providers fire safety arrangements were unsafe. People’s care plans were not sufficiently detailed to ensure people received safe, appropriate care and records showed people did not always receive the support they needed. Staff were kind and patient with people when providing support but they did not always ensure people’s privacy and dignity was respected at all times.

The management of medication was unsafe. There were no effective systems in place to ensure people received their medicines as prescribed or to ensure that medicines in the home could be accounted for. During our visit there were two doses of controlled drugs missing and two people’s medicines had run out.

People were not supported to have maximum choice and control of their lives. Staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice or the application of the Mental Capacity Act 2005 (MCA).

Accident and incidents were not properly investigated to ensure that staff learned from these events to prevent them from happening again in the future. Records showed that people sometimes sustained accidental injury during the delivery of support. This suggested that staff did not always show due care when supporting people. Furthermore, where the provider was legally required to report accidents and incidents to CQC they had not always done so.

The premises and the facilities available to people who lived in their home were not always suitable or sufficient. For example, there was a lack of communal bathrooms, the garden was not secure for people to be able to use independently and the smoking room within the home was hazardous.

As a result of the above, service delivery failed to adhere to legal requirements or best practice in respect of people’s care. For example, NICE guidelines for the management of medication, health and safety guidance with regards to fire safety in care home, Department of Health infection control standards or MCA Code of Practice.

People received enough to eat and drink and told us the food and drink on offer was satisfactory. They had access to a range of activities and trips out in respect of their social and recreational needs and the atmosphere at the home was relaxed and homely. There were a range health and social professionals involved in people’s care.

Staff members employed at the service were recruited safely. The number of staff on duty was sufficient to meet people's needs and staff had received sufficient training and support.

People told us the staff were nice and it was clear from our observations that people felt comfortable with the staff members supporting them. Staff spoken with, spoke with genuine warmth about the people they care for and knew how to safeguard people from the risk of abuse.

Rating at last inspection and update:

The last rating for this service was requires improvement (published 1 August 2018). At this inspection there were breaches of the regulations. The provider completed an action plan after this inspection to show us what they would do and by when, to improve. At this inspection we found that adequate improvements had not been made and the provider was still in breach of the regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will also request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service will be placed in special measures. ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Our last inspection of the service was on 8 March 2016, when we found that the service was good in four areas but required improvement in the ‘effective’ domain. We found a breach of Regulation 11 of the Health and Social Care Act 2008: need for consent, because not all staff had received training about mental capacity and consent, and arrangements for the covert administration of medication were not compliant with the requirements of the Mental Capacity Act 2005. During this inspection we found a continued breach of Regulation 11.

We found a breach of Regulation 18 of the Health and Social Care Act 2006: staffing, because not all staff had completed the provider's comprehensive programme of training to ensure that they knew how to support people safely.

There was a breach of the Care Quality Commission (Registration) Regulations 2009: Regulation 18 because the provider had failed to notify CQC of occurrences at the home.

There was also a breach of Regulation 17 of the Health and Social Care Act 2006: good governance, because the provider did not have effective governance, including assurance and auditing systems or processes, to identify where improvements were needed.

The home is required to have 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. The home had a registered manager who had been in post for several years.

The care files we looked at showed that people’s care and support needs were assessed covering their health and personal care needs and plans were written for the care and support people needed. These were kept up to date with monthly reviews. We found that the care plans lacked person-centred detail and some inappropriate language was used.

The home was clean and there were no unpleasant smells. Some improvements had been made to the environment since our last inspection. Maintenance records showed that regular checks of services and equipment were carried out by the home’s maintenance person and testing, servicing and maintenance of utilities and equipment was carried out as required by external contractors.

People had a choice of spacious sitting areas on the ground floor. These included a 'garden lounge', which was a quiet area with no television; a 'ballroom' where activities took place; a smokers' lounge; and a conservatory. People were free to walk around and choose where they wanted to spend their time.

Medicines were stored safely and people received their medication as prescribed by their doctor.

There were enough qualified and experienced staff to support people and meet their needs, and people we spoke with considered there were enough staff. Staff had received training about safeguarding vulnerable people from abuse.

Risk assessments were recorded in people’s care notes and plans put in place to reduce the risks identified. A log of accidents and incidents was maintained.

People told us they enjoyed their meals and had plenty to eat and drink.

People who lived at the home told us that the staff provided them with good care and support and we observed that staff treated people with kindness and respect. People we spoke with described the staff as kind and caring and we observed positive and respectful interactions between staff and people who lived at the home. People told us they enjoyed the activities and trips out.

Regular meetings were held for staff and for people living at the home. The staff we spoke with told us they enjoyed working at the home.

The home is required to have 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. The home had a registered manager, however he was on holiday when we did the inspection.

During the inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008: Need for consent. You can see what action we asked the provider to take at the end of this report.

During our visit we saw that there were enough staff to support people and meet their needs, and people we spoke with considered there were enough staff. People we spoke with described the staff as kind and caring and we observed positive and respectful interactions between staff and people who lived at the home. Staff had received training about safeguarding vulnerable people from abuse and about caring for people living with dementia.

The home was clean and there were no unpleasant smells. Some improvements had been made to the environment since our last inspection. Medicines were stored safely and people received their medication as prescribed by their doctor.

People were registered with local GP practices and the care plans we looked at gave details of people’s health needs. People’s needs were assessed before they moved into the home and referrals were made to medical professionals as needed. Care plans recorded the care and support people received.

People who lived at the home had a choice of spacious sitting areas on the ground floor. These included a 'garden lounge', which was a quiet area with no television; a 'ballroom' where activities took place; a smokers' lounge; and a conservatory. People were free to walk around and choose where they wanted to spend their time. People told us that they enjoyed the social activities provided and regular trips out.

People spoke highly of the home manager and staff considered that they worked well together as a team.

Is the service safe?

Records showed that people had home visits from health professionals including district nurse, community matron, chiropody, GP, dentist, dietician, and were supported to attend medical appointments. Some of the people who lived at the home had dementia and received support from community mental health services.

Risk assessments were recorded with regard to environment, nutrition, healthcare related conditions, manual handling and mobility and these were updated monthly by the manager.

An accident and incident log was in place and this enabled monitoring and identification of any recurrent events.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Appropriate storage facilities were provided and medicines were handled only by senior staff who had received appropriate training.

There were enough qualified, skilled and experienced staff to meet people's needs and all grades of staff were supported to extend their knowledge and skills.

Is the service effective?

We observed that people's social needs were catered for and people told us:

'The activities are really good.'

'We have a dance sometimes.'

'We really enjoyed the trip yesterday.'

'I help in the hairdressers.'

The care staff we spoke with had a good knowledge of people's individual care and support needs and they had all completed dementia awareness training.

During our visit we were able to speak with two professional visitors. One said that they had not visited the home much recently, but they considered that the service had improved and staff were more approachable. The other person told us 'The home has improved. The staff are very helpful and the manager is on the ball.'

Is the service caring?

We observed care workers interacting with people in a positive and friendly manner and offering people choices, for example 'Would you like to go through to the other room?'. People told us 'They are good to you here.' and 'They do look after you.'

A relative who had come to pick up a person who had been having a respite stay at the home told the manager that they were delighted with the care and hoped to use the service again in the future.

Is the service responsive?

People who lived at the home had a choice of spacious sitting areas on the ground floor. They were free to walk around choose where they wanted to spend their time. A variety of social activities took place every afternoon including two minibus trips out each week. One person we spoke with told us 'I've got a mind of my own and I please myself what I do.'

The care plans showed that people's close relatives were consulted about their care and kept informed as appropriate. A section of the care plans was 'My Life Story' and this was completed using information from the person, if able, and from their family. A 'Do Not Attempt Resuscitation' form was included in one of the files we looked at and this had been signed by the person's GP and by a close family member.

The care files contained assessments that had been completed before the person went to live at the home. Assessments had been carried out by a senior member of the home's staff and there was also information from social services. These ensured that Victoria House would be the right home for the individual and their needs could be met.

The manager told us that three people at the home had Deprivation of Liberty Safeguards in place and full records were available to show the process that had been followed. An advocate was involved in the case of one of these people, and for another person, funding had been secured for a member of staff to accompany them on regular trips out.

Is the service well led?

During our visit we were able to speak with the service provider who is a medical practitioner. He told us that he visited the home at least weekly and had a good working relationship with the registered manager. The manager and the deputy manager held a management meeting every Monday. We saw that checking and monitoring processes were in place covering accidents, medicines, care plans, and environment. People we spoke with confirmed that they knew the manager and the home owner and were able to speak to them.

Both the manager and the deputy manager had achieved a national vocational qualification (NVQ) level 4 in management and had considerable experience in care work. Senior care staff had NVQ level 2 and/or level 3 and were working towards a team leadership qualification.

At this visit our tour of the building showed work was being carried out to improve the safety of the building and to improve the standard of d'cor and furnishings. We spoke with two people who used the service and two family members all told us they had The registered manager provided information and records that showed there was a maintenance programme in place that was regularly monitored.seen improvements in the d'cor and furnishings and facilities and were happy with the improvements that had been made.

"I am very happy living here and the staff are very kind and help me when I need it.'

'I have not been very well and the girls have looked after me so well, they call the doctor to come and check on me.'

We spoke with two family members who told us they were happy with the standard of care provided to their relatives.

We sought information from Wirral Department of Adult Social Services. They told us that they had seen improvements in how the service was managed and the care and support offered to people.

We looked at four care records that showed care and support was planned and delivered in a way that ensured people's safety and welfare. They also reflected their individual needs.

People told us they felt the management and staff team respected them and valued their right to make decisions for themselves. We also spoke with the relatives of two people who told us they would raise any concerns with the manager or deputy. Records held by the CQC showed the manager had responded appropriately to safeguarding concerns.

A tour of the building showed work had been carried out to improve the facilities and the environment for people, however further work was needed to ensure the environment and facilities were safe and met people's needs.