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Inspection carried out on 10 January 2019

During a routine inspection

What life is like for people using this service:

The property was clean, comfortable, with plenty of room for people to live. Everyone had their own room with en-suite facilities.

People told us they felt safe and happy and the service was their home.

There were safeguarding systems and processes in places that sought to protect people from harm. Staff knew the signs of abuse and what to do if they suspected it. There were sufficient staff in place, all of whom had passed safe recruitment procedures to ensure they were suitable for the role. There were systems in place to monitor people's safety and promote their health and wellbeing, these included risk assessments, risk management analysis tools and care plans. The provider ensured that when things went wrong, incidents and accidents were recorded and lesson were learned.

People needs were assessed in detail before moving to the home so the provider knew whether they could meet the person's needs. Staff were sufficiently skilled and experienced to fulfil their roles, received training and were supported through regular supervision. People were prompted to eat and drink healthily and could choose what foods they wanted to eat. People were supported to have choice in their daily lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were treated kindly and compassionately by staff. People and their relatives were supported to express their views and make decisions about the care and treatment they received. Staff respected people's privacy and dignity.

People received personalised care, having their support needs and preferences detailed in their care plans. People were supported to lead fulfilled lives through activities of their choice. The provider had a complaints policy and process in place; people and their relatives told us they would feel comfortable raising complaints. When people were at the end of their life, the provider worked with them to meet their wishes and preferences and to live pain free.

People and staff thought highly of the registered manager and that the service was well managed. Staff knew their roles and understood what was expected of them. The registered manager knew their responsibilities in ensuring people received a safe, high quality service. People and staff were engaged in the service and their opinions were sought. There were quality assurance systems in place to assist the provider to monitor and improve its care and treatment of people. The service had built local community links to benefit the lives of people using the service.

At this inspection we found the evidence supported a rating of ‘Good’ in all areas, and continues to support a rating of ‘Good’ overall. More information in 'Detailed Findings' below.

Rating at last inspection: At our last inspection in April 2016 we rated the service as ‘Good’ overall, we rated Safe as ‘Required Improvement’.

About the service: Victoria Mews is a residential care home that provides personal care for up to 30 people. At the time of the inspection 29 people lived at the home.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

Inspection carried out on 12 April 2016

During a routine inspection

We carried out an inspection of Victoria Mews on 12 April 2016. The inspection was unannounced.

Victoria Mews provides accommodation with personal care for up to 30 people. There were 26 people living in the home at the time of our inspection. All of the people were living with dementia.

There was a registered manager 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.

The service was last inspected on 18 and 19 August 2015 when we found the provider was not meeting the required standards. We identified one breach in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to improve staffing arrangements and their procedures for safeguarding people from risks and abuse. We asked them to take the necessary steps to ensure the required improvements were made.

The provider sent us an action plan which stated all the required improvements would be completed by 31 January 2016. During this inspection we checked improvements had been made. We found overall improvements had been made and sufficient action had been taken in response to the breach in regulations.

People told us they felt safe living at the home and we saw enough staff on duty to keep people safe. Since the last inspection staffing arrangements had been reviewed and changes had been made to ensure there were enough suitable staff to meet people’s needs.

Risk assessments and management plans were in place to minimise the risks to people’s safety. However, guidance for staff to follow to manage risks was not always in place. Therefore, we could not be sure people were always being kept safe.

People received their medicines as prescribed and medicines were stored safely. Since the last inspection the administration of topical medications (medicines applied directly to the skin) had been reviewed and improved.

Since the last inspection care staff had completed further training in manual handling to help them carry out their roles safely and effectively. New staff received an induction prior to working unsupervised and staff received training in health and social care to develop their skills further.

Recruitment checks were carried out prior to staff starting work at the home to make sure they were suitable for employment.

The registered manager understood their responsibilities in relation to the Mental Capacity Act (2005). Since the last inspection capacity assessments had been completed for those people who lacked capacity, so decisions could be made in their best interests. The correct action had been taken for restrictions in people's care to be authorised. Staff understood their responsibility to seek people's consent before they delivered care.

People told us they enjoyed the food and said they were able to have drinks and snacks throughout the day. Since our last inspection processes to monitor the food and fluid intake of people at risk of dehydration or malnutrition had improved. However, further improvement was required to ensure the records were completed correctly.

There had been significant improvements to the environment and social activities since our last inspection. This had a positive effect on people and was now more suited to people living with dementia.

People and their families were positive about the care being provided, and knew how to make a complaint.

Care plans were in place and contained more detailed information about people since the last inspection. Care staff we spoke to did have a good understanding of people’s care and support needs however, further improvement was required in this area.

Both the provider and registered manager were comm

Inspection carried out on 18 and 19 August 2015

During a routine inspection

This inspection took place on 18 and 19 August 2015. It was an unannounced inspection.

Victoria Mews provides accommodation with personal care for up to 30 people. There were 27 people living in the home at the time of our inspection. Everyone living at Victoria Mews was living with dementia.

There was a registered manager 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.

The provider determined the staffing levels on the number of people living in the home instead of on an assessment of people’s needs. On the first day of our visit we found that most of the staff on duty were not permanent members of staff and had limited knowledge about people’s care and support needs. Staff were rushed; people’s needs were not always met in a timely manner and staff were not always following plans to manage identified risks to people’s health and wellbeing.

Staff understood what constituted abuse or poor practice. There were systems and processes in place to protect people from the risk of harm. Most medicines were managed safely and in accordance with good practice. However, improvements needed to be made in the management and storage of topical medicines that were applied directly to the skin.

Staff received training to meet the needs of people living in the home, but we found staff were not always implementing the training effectively into their practice. Staff supervision, which may have identified areas where staff needed further support to develop their skills, were not consistently taking place.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We were told some people lacked capacity in certain areas but capacity assessments had not been completed to show how people were supported to make those decisions.

People received food and drink that met their nutritional needs and were referred to other healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach, but the main interaction with people was focussed on offering support or completing a care task. Permanent staff we spoke with had a good understanding of people’s support needs, but had limited knowledge of their backgrounds. This meant people were defined by what support they needed rather than who they were.

People felt confident they could raise any concerns with the registered manager. There were processes in place for people to express their views and opinions about the home.

There were systems in place to monitor the quality of the service. This was through feedback from people who used the service, their relatives, staff and a programme of audits. The provider played an active role in quality assurance to ensure areas of poor practice could be identified so the service could improve. Quality monitoring visits had not identified some of the areas of concerns we found during our inspection visits.

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

Inspection carried out on 4 September 2014

During a routine inspection

This inspection was completed by two inspectors and an expert by experience. During our visit we spoke with the registered manager and five care staff.

We found there were 30 people living in the home at the time of our inspection. We were able to speak with three people and four visiting relatives about their experiences of the care and support they received at Victoria Mews.

We carried out observations of care throughout the home. The evidence we collected helped us to answer five key questions: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary described what we observed, the records we looked at and what people using the service, staff and visiting relatives told us.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

We found staffing levels at the home met the needs of the people. The manager told us they had recently increased staffing numbers by one care staff member in the morning and one at night. Staff we spoke with told us this increase in staffing had helped. One staff member told us, "They gave us an extra staff member in the morning. It has definitely helped."

We found people received their medicines as prescribed. There were arrangements in place to protect people against the unsafe use and management of their medicines.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes and hospitals. The manager was aware of their responsibilities under the legislation and the potential impact of a recent court judgement in relation to DoLS. One person had a DoLS in place at the time of our inspection.

Is the service effective?

During our visit we spent time speaking with people who used the service and their relatives. People were happy with the care provided. One person said, "It's nice here, the staff are all kind, I like them." A relative told us, "I think she is quite happy here, they seem to look after her care needs. She is always clean and tidy, she seems so happy here. All the family are happy with her care."

Care plans provided staff with the information they needed to meet people's individual needs. Risk assessments had been completed to look at the risks associated with the care needs of each person and informed staff how they were to deliver care to reduce those risks. Care plans and risk assessments were evaluated regularly and reflective of the care provided. Staff we spoke with had a good knowledge about people's individual care needs and the support they required.

Is the service caring?

During our visit we saw staff were respectful towards people and always spoke to them by name. This meant people had a sense of identity and belonging within the home. One person told us, "I've been here quite a while, it's nice here, the staff look after me, I feel safe. They all use my Christian name, they all know me. The staff are respectful to me, never not nice."

Staff were patient with people and did not rush them when supporting them with care.

Is the service responsive?

We saw staff reassured people when they became agitated, concerned or distressed.

Since our last inspection in February 2014, we found the environment had been developed to make it more friendly to people with dementia. During our visit we saw staff engage people in conversations about their likes and histories. One person told us, "We have a garden which I go into sometimes; we have sing songs as well. They sit with me sometimes and we go through books, I would like to do it more." Another person said, "I do some of the activities like the quiz and bingo, but not many. Mostly I just sit around, I prefer that."

Is the service well led?

We saw the service maintained a system of audits and reports which identified areas where improvements were needed to ensure the service provided was safe and effective.

A recent analysis of falls within the home had identified that there were a higher number of falls in the evening. As a result there had been a change in a shift so there was an extra member of staff on duty during the risk period. This meant learning from incidents took place and appropriate changes were implemented.

Inspection carried out on 11 February 2014

During an inspection to make sure that the improvements required had been made

We visited Victoria Mews on 26 September 2013 and found the provider was not meeting all the required standards we would expect care services to provide. This was because care was not always planned and delivered in a way that was intended to ensure people's safety and welfare. We set a compliance action that let the provider know they needed to improve. In October 2013 we received a report from the provider that told us what they had done and what they planned to do to improve the service provided. In January 2014 we received information of concern about staffing within the home.

We visited the service on 11 February 2014 to check the actions taken by the provider to correct the issues we had identified in September 2013. We also looked at the organisation of staffing on the day of our visit.

People living at Victoria Mews had dementia care needs. We spent time observing the care and support they received. We spoke with two visiting relatives, six members of staff, the manager of the home and the quality assurance manager.

We found the provider had made improvements in care records and there were care plans in place to support people's identified needs. We saw staff were friendly and approachable to people and in supporting them. However, from our observations and from talking to staff we found staffing arrangements were not effective in the morning. We found staff were often rushed and spent their time recording information rather than supporting people.

Inspection carried out on 26 September 2013

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at the time of our inspection. Their name appears because they were still the manager on our register at the time. The new manager Zoe Bradbrook-Henry had been in post for twelve weeks and had submitted their application for registration.

People living at Victoria Mews had dementia care needs. We spent time observing the care and support they received. We spoke with three visiting relatives, two staff members, the manager of the home and the area quality manager.

Relatives spoke positively about the care their family members received. One relative told us, "We come every day. There isn’t a day we don’t come and every day we are welcome. It is a really warm and wonderful place and I really enjoy coming here.”

Care plans were in place to provide staff with information about how they were to support people. Some care plans did not always address risks to the health and welfare of people.

Comments we received about staff from visiting relatives were positive. One relative told us, “They are all lovely. They are really caring. They are all good.” Another visitor described staff as “very obliging”. We were satisfied staff knew how to respond to potential safeguarding concerns.

There was a process in place for dealing with and responding to complaints. A relative said, "If we have had anything to say it has always been resolved there and then.”

Inspection carried out on 15 February 2013

During a routine inspection

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of this inspection. Their name appears because they were still a Registered Manager on our register at the time.

We met with 17 of the 24 people using the service at the time of our inspection. We also spoke with the deputy manager, four care staff and the area quality manager who was visiting the care home at the time of our inspection.

People were treated respectfully. We saw staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We observed that staff were kind, caring and attentive towards people using the service. We saw that staff explained what they were doing at a level and pace the person could understand.

We were concerned that care plans were not always available to address risks to the health and welfare of people using the service. This meant timely action might not have been taken to minimise the risks.

We found that the care home was clean and hygienic. Arrangements were in place to minimise the risk of infection.

We saw evidence that satisfactory pre-employment checks were made before staff started working with people who used the service.

We found that records relating to the day to day running of the service were accurately and securely maintained.

Inspection carried out on 5 January 2012

During an inspection to make sure that the improvements required had been made

We made an unannounced visit to this care home on 5 January 2012. This was our first review of this service since it was registered with a new provider in October 2011.

The registered manager of this service has been absent for several months. The provider has made alternative arrangements for the management of the home and a relief manager has been running the home since October 2011.

There were 25 people using the service when we visited. We met with 14 of these people.

People using the service at Victoria Mews have dementia care needs, which meant they might have difficulty engaging in complex conversations with us.

We spent time in two lounge areas closely observing people’s experience. We looked at their mood, how they spent their time and how staff interacted with them.

We looked at three people’s care records and spoke with the manager, the administrator and four care staff. We looked at some records relating to the running of the home.

We saw that people were not left unattended for extended lengths of times. There was a staff presence in communal areas. We saw staff sitting and chatting with people when they were not involved in a task to meet a particular care need. People appeared to be comfortable in approaching staff with their requests and staff responded quickly.

We observed that staff treated people respectfully. People were addressed by their preferred names and staff were discreet when asking about care needs. Staff gave sensitive explanations when they were helping people, speaking to them at a pace and level appropriate to their individual needs.

We found that, overall, the service was meeting the care and welfare needs of people using the service.

There are systems in place to respond to suspicion or allegations of abuse to make sure people using the service are protected from harm.

We found evidence that showed people’s health and safety are promoted because systems are in place to monitor the quality of the service provided.