We carried out a review of the data available to us about Victoria House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Victoria House, you can give feedback on this service.
Victoria House is a care home providing personal and nursing care to up to 30 older people, some of whom were living with dementia. At the time of our inspection there were 27 people using the service.
People’s experience of using this service and what we found
The provider had improvement plans in place. However, service design and decoration was in need of refurbishment in some areas. Signage was not in place to assist people living with dementia to orientate themselves around the home. Some people's rooms were not personalised, and some people were required to share rooms. People were offered choice of meals and people told us they enjoyed their meals. At our previous inspection we recommended the provider introduced staff training in line with the Care Certificate standards: at this inspection this was not embedded into practice. Staff had received some training to support people in line with their needs, however some training regarding clinical skills, staff understanding their role and professional development was not provided. Staff told us they were supported in their roles and received regular supervisions. New staff received an induction and shadowing opportunities.
Peoples needs and choices were assessed and documented in person centred care plans, this included people's communication and end of life care needs. We observed staff offering choice to people during our inspection and people told us staff respected their privacy and dignity. The staff team worked closely with external agencies to ensure people's healthcare needs were met. 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.
Systems and processes were in place to protect people from the risk of abuse and avoidable harm. Risks to people were assessed and people and their relatives told us they felt safe in the home. Environmental and equipment checks were in place. However, we found hoist slings were not labelled, with people sharing slings. The registered manager provided assurances following the inspection that this concern was now rectified, to promote safety and reduce the likelihood of cross contamination. People were supported by enough staff who were recruited safely. People and their relatives told us there were enough staff and staff were kind. Medicines were safely managed. The service was clean, and systems were in place to control and prevent the spread of infections. There were no recent accidents or incidents. Systems were in place to monitor and review incidents which may occur.
Staff knew people well. A ‘resident of the day’ system was ongoing to ensure people were offered the opportunity to provide feedback and auditing of care records was undertaken. The registered manager understood their roles and responsibilities in relation to duty of candour and reported incidents to CQC and safeguarding where required. Staff understood their roles and responsibilities. People, relatives and staff told us leadership was good and there was an open and honest culture in the home. The registered manager received support from a regional management team. People were supported to maintain relationships and to receive visitors to maintain their religious and cultural needs. Regular audits were conducted, and overarching governance was in place. Improvement plans were in place and the service was currently conducting refurbishments of the environment, however not all areas identified during the inspection had been considered.
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 requires improvement (published 1 July 2021).
Why we inspected
This inspection was prompted by a review of the information we held about this 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.
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 requires improvement to good based on the findings of this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria House on our website at www.cqc.org.uk.
Recommendations
We have made a recommendation the provider reviews staff training to incorporate the Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Victoria House is a residential care home providing personal and nursing care for up to 30 people. Some people using the service were living with dementia. At the time of our inspection there were 25 people living at the home.
We have made a recommendation about governance as not all audits identified issues and action plans were not always carried out in a timely way. We recommend the provider review their governance systems to highlight inconsistencies and recording issues to ensure records are up to date and accurate. The feedback we received about management and leadership was positive, with the current staff team speaking of a positive culture at the home. They told us they were happy in their jobs and felt supported by the registered manager.
People's experience of using this service and what we found
People told us they felt safe living at Victoria House. There were systems in place to recognise and respond to any allegations of abuse. Medicines were stored safely and administered as prescribed. Staff were knowledgeable about people's risks and assessments were carried out. There were enough staff deployed to meet people's care and support needs in a timely way. We observed staff consistently wearing PPE appropriately throughout the premises. Staff were knowledgeable about their infection control responsibilities as they had received training and guidance.
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 Good (published 9 February 2021).
Why we inspected
The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe 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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Victoria House on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
Victoria House is a residential care home providing personal and nursing care for up to 30 people. Some people using the service were living with dementia. At the time of our inspection there were 18 people living at the home.
People's experience of using this service and what we found
People were safeguarded from the risks of abuse. Staff received training in this area and knew how to recognise and report abuse.
Risks associated with people's care were identified and risk assessments were in place to minimise the risk.
Staff were knowledgeable about risks associated with people's care.
Accidents and incidents were monitored, and trends and patterns identified. Lessons were learned when thinks went wrong.
People received their medicines as prescribed. Competency checks were carried out and staff were knowledgeable about medicine management.
The provider had a robust recruitment procedure which ensured new starters were recruited safely.
We observed staff interacting with people and socially engaging with them. Staff we spoke with felt there were enough staff. They also told us that the management team was supportive and assisted them when needed.
The provider made sure infection control processes helped keep people safe during the COVID-19 pandemic. The home was clean and there were PPE stations situated at several point throughout the home.
The provider had managed the current pandemic well and implemented effective procedures.
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 08 June 2019). At this inspection we found improvements had been made.
Why we inspected
The inspection was prompted in part due to concerns received about a COVID-19 outbreak at the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led.
Prior to the inspection, we reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.
Ratings from previous comprehensive inspections for the key questions of Effective, Caring and Responsive were used in calculating the overall rating at 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 coronavirus and other infection outbreaks effectively.
The overall rating for the service has changed from requires improvement to good. 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 on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
People felt safe and staff used health and safety equipment safely. People had risk assessments although information about risks to people was not always comprehensive. There were enough staff to keep people safe, but the staffing arrangements did not always provide sufficient time for staff to give person centred care. Medicines were managed safely. Staff followed infection control procedures and received infection control and food hygiene training.
Staff had the skills and knowledge to deliver care effectively and they received good support from the team and the registered manager. Systems were in place to make sure people’s health and nutritional needs were met. People were comfortable in their environment; the provider was improving the décor.
At the last inspection the provider was not supporting people to have maximum choice and control of their lives. At this inspection they had improved how they supported people to have maximum choice and control, but further improvements were required. The policies and systems in the service required further development to support this practice.
People who used the service, family and friends, without exception, provided positive feedback about the service and were complimentary about staff and management. Other professionals told us the service was caring.
The provider was introducing a new electronic care recording system. The transition had created some difficulties which resulted variable care plans. The registered manager was looking at ways of involving people more in the care planning process. People engaged in one to one and group social and leisure activities. During the inspection ‘Friends of Victoria House’ were holding a coffee morning. This was a pleasant and lively atmosphere, and well attended.
Feedback about the registered manager was consistently good. People who used the service and visiting relatives and friends told us they would recommend the service to others.
Quality management systems were in place but these were not always effective because they did not always drive improvement. The provider had not identified some of the issues picked up during our inspection. The registered manager was responsive and where appropriate, took swift action to address shortfalls. They were keen to develop and improve their quality management systems and provide people with consistently high quality care.
Rating at last inspection: Requires improvement. The report was published on 28 April 2018.
Why we inspected: This was a planned inspection based on the rating at the last inspection.
Follow up: We will continue to review intelligence about the service and visit again within our recommended return inspection timescales. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Victoria House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Victoria House accommodates 30 people in one adapted building. On the day we inspected 24 people were living at Victoria House.
There was a registered manager in post and they were available during the inspection. 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 safe and we saw staff were pro-active in their interventions, such as preventing a person from falling off their chair by encouraging them to move backwards into the seat. Staff knew how to report any safeguarding concerns and any incidents which occurred within the home such as falls or pressure damage, were considered to see how practice could be improved.
Risks were managed well, with regular checks of equipment and the premises. However, some records needed further detail to provide specific guidance for staff in relation to equipment and methodology used.
Staffing levels were appropriate and meant people had their needs met promptly. Medication administration practice was safe and checks were in place to ensure procedures and knowledge were correct.
The registered manager understood what constitutes good practice and led by example. However, they were not always aware of the latest guidance to follow. They reassured us they were in the process of reviving many of the policies and procedures which were out of date.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service did not support this practice.
Staff received an induction, supervision and training, however, not all new staff completed the Care Certificate which is accepted best practice for people new to care.
We observed people actively supported with nutrition and hydration needs were met regularly. People and relatives we spoke with confirmed how much emphasis was placed on ensuring sufficient fluid intake. People also accessed external health and social care support as required.
Staff displayed kindness, compassion and interest in the people they were caring for. It was evident they knew people and their relatives very well, sharing high levels of conversation and enabling people to engage with as much as possible around them. Privacy and dignity was respected at all times.
Care records were comprehensive and regularly evaluated. People enjoyed a range of activities at both individual and group level.
The service had not received any complaints but had received many compliments.
The home had a positive, welcoming atmosphere where everyone was acknowledged and felt included. This vision was shared with all staff and led by the registered manager who had strong values. This culture was embedded in practice and culture.
There was a robust quality assurance system in place with evidence of actions being taken promptly where issues were noted. People who lived in their home and their relatives’ views were sought in shaping the home and the delivery of care.
We found one breach of regulations in relation to the need for consent and made a recommendation in relation to ensuring completion of the care certificate. You can see what action we told the provider to take at the back of the full version of the report.
There was a registered manager in place. 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 was friendly and welcoming and people, staff and visitors reported a homely atmosphere.
Staffing levels were appropriate to meet people’s needs and secure recruitment procedures ensured staff were suitable to work with vulnerable people.
Medications were not always given to people as prescribed and there were some errors in accounting for medication.
Staff understood the Mental Capacity Act and the implications for their work in ensuring people’s rights were promoted.
Staff were motivated and dedicated to their work with people. Staff were supported to carry out their work and they had opportunities for regular training and supervision.
People were central to the work and staff were passionate about caring for them. There was evidence of a good rapport with people and their families.
People’s dignity and respect were maintained at all times in their care and routine.
The activities coordinator knew people’s social histories and engaged with people on an individual basis or in group activities according to their needs.
Care records contained accurate information and regular reviews of care were evident.
People and their relatives knew how to raise a complaint if they felt this was necessary.
The registered manager was visible in the service and knew each person well. People, staff and relatives and visiting professionals said the home was well run and managed.
Systems were in place to monitor the quality of the provision and drive improvement.
You can see what action we told the provider to take at the back of the full version of the report.
This inspection was unannounced and took place on 28 January 2015. At the last inspection on 19 June 2013 we found the provider was breaching regulations relating to care and welfare of people who use services, cleanliness and infection control and respecting and involving people. At this inspection we found the provider was still in breach of the respecting and involving people regulation. We also found there was a breach of the assessing and monitoring the quality of service provision regulation.
Victoria House provides accommodation and personal care for up to 30 older people some of whom may also require nursing care.
At the time of our inspection the home had 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.
Medicines were administered to people by trained nursing staff. Nurses administering medicines wore a red tabard which indicated they should not be disturbed. We saw the practice was effective.
We reviewed some people’s medication administration records and an incorrect dose of a person’s medication had been administered. We spoke with the nurse who administered the medication who confirmed a drug error had occurred and this would be reported to the relevant organisations.
Staff we spoke with told us they were aware of how to detect signs of abuse and were aware of external agencies they could contact. People who lived at Victoria House told us they felt safe living there. One person said, “I do feel safe here.”
We looked around the communal areas of the home and in some people’s bedrooms. The home was clean and odour free. Bathrooms contained soap dispensers and paper handtowels. There was sufficient personal protective equipment for staff to use including disposable gloves, aprons and hand gel.
We arrived at Victoria House at 7.30am and found 15 people lined up in the main lounge, conservatory and small lounge. 11 of the 15 people were sat in wheelchairs with little stimulation. When we asked staff why this was we were told they were waiting to be taken into the dining room for breakfast which was at 8am.
People generally had a good choice of food, however, we saw one person being supported to eat food which was pureed and looked unappetising. We were unable to identify what the food was. The chef told us the meal was the same as everyone else’s but just pureed.
We noted two toilets on the ground floor for the use of people living at the home. The toilets were not large enough for them to be accessed easily by wheelchair users, the provider had improvised by adding external curtains which were drawn when the toilets were in use. However, the door was left open which did not maintain people’s privacy and dignity.
Staff with whom we spoke said they had received training in the Mental Capacity Act 2005 (MCA) and specifically on the Deprivation of Liberty Safeguards (DoLS). Care staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.
The provider had a comprehensive training programme in place. We saw the training matrix which detailed the dates of staff training; this ensured the registered manager knew when staff should attend refresher training.
During the day we observed some good caring practices. Staff always took the time to speak with people living at Victoria House and pass the time of day with them. One person we spoke with told us, “They treat me kindly and speak to me nicely.”
We spoke with six people who used the service who said they had little choice in their daily routines. One person said, “I have no choice in where I sit, they just bring me in here.”
We looked at three people’s plans and found them comprehensive and easy to navigate. Care plans were written in a person centred way and a full assessment of people’s care needs had been carried out prior to them moving to Victoria House. They contained up to date information based on people’s current health requirements.
Quality assurance systems in place in the home to monitor whether the service was providing high quality care were not robust.
People who used the service and staff all spoke very highly about the registered manager of the service. One member of staff said, “I feel very supported by the manager and everyone else working here.”
You can see what action we told the provider to take at the back of the full version of the report.
We found that there were sufficient staffing levels through the day time but there were issues around the early morning staffing levels.
We found that there was a lot of activity within the home during the early morning with peoples' lights being turned on and staff conversing with them. We saw that televisions and music were playing whilst staff were carrying out their duties.
We observed people sleeping in the lounge area and when we discussed the reasons for this with people and staff we found that this was due to poor management of care.
We found the communal areas of the home to be clean in appearance, however there were odours in some of the bedrooms.
We saw that people were well cared for during the daytime and saw recognition of the care people received through thank you cards displayed in the entrance area.
We spoke with the relatives of two people who were happy with the care being provided. Comments included:
'They just do a good job really.'
'Staff are lovely, all really nice.'
People using the service said they are very happy and if they have any concerns they would talk to the care staff. People also said they feel safe and well cared for. One visiting relative says their relative is very happy and well cared and safe. They went on to say Victoria House is a really good place to be.
People said they like living in the home. One person said they like their room they have everything they need. One visiting relative said the home is always clean and their relative is comfortable and well cared for.
People living in the home said they like the carers as they listen to what they say and are polite and courteous at all times. One visiting relatives says the staff are excellent and they couldn't ask for better care.
People said they like the staff caring for them. One person said the carers are lovely and you couldn't ask for better care. Another says the staff are very good indeed and are always ready to help you if you need anything. Two visiting relatives said the staff are excellent and they have never had any issues regarding the services and care provided.
We observed people relaxing around the home and those supporting them looked confident and comfortable in their work.
People said they are asked if they are happy with the care and services provided. Two visiting relatives said that they get a satisfaction questionnaire every year to complete and they have never had any issues about standards in the home.
People living in the home said if they have any complaints they tell the staff and things are sorted out right away
Two visiting relatives said they had no issues and felt that people are well cared for and if they had any complaints they felt confident that they would be dealt with.