Victoria House Also known as Victoria House North East Limited

Victoria House is a residential care home converted from three terraced houses. Residential care is provided for people who have a learning disability, physical disability or those with autism. The service provides personal care and support to up to 9 people. At the time of the inspection there were 9 people living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support

The service was registered with CQC prior to the publication of the Right support, right care, right culture guidance. The size of the service was larger than current best practice guidance. However, the layout of the building meant there were separate communal areas people could access to decide who they wanted to socialise with.

Records did not always demonstrate medicines were managed safely. The policies and procedures in place lacked detailed guidance of how staff should provide support. The infection, prevention and control [IPC] policy and procedure did not provide detailed information in relation to safe practices to help prevent the spread of infections. The safeguarding policy did not evidence the provider understood their responsibilities in relation to safeguarding procedures.

People were supported to personalise their bedrooms to reflect their taste and preferences and their opinions were sought to ensure people were included in decisions about their care. Risk assessments were completed to assess known risks people were exposed to and people were encouraged to be as independent as possible.

Right Care

There were sufficient numbers of staff to meet people's needs. Staff knew people well and knew the most effective ways to communicate with people to overcome any communication barriers. Information was available to people in alternative formats to support people's communication needs if this was necessary.

Staff treated people with care and kindness and supported people to take part in a range of activities appropriate to them. Assessments of people's needs had been completed and care plans had been developed to meet people’s needs.

Right Culture

The culture at the service was positive. The management team led by example and staff worked in ways which were person-centred to the needs of individuals. People and relatives gave positive feedback about the caring attitudes of staff.

People were supported to take part in activities of their choosing and had opportunities to socialise and go on holiday if they wanted to. Feedback from people confirmed they were happy living at the service and felt safe.

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 this practice.

Recruitment records did not demonstrate safe recruitment procedures were always followed. Staff worked in an open and transparent way. However, records were not available to demonstrate staff were meeting the requirements of the duty of candour regulation. We have made a recommendation about this.

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 20 September 2019).

Why we inspected

We received concerns in relation to the management of the service and support provided to people. As a result, we undertook a focused 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.

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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report. The provider started to take action to address the issues identified during our inspection.

You can see what action we have asked the provider to take at the end 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.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from the risk of abuse and good 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Victoria House is a residential care home converted from three terraced houses. Residential care is provided for people with a learning disability, physical disability or those with autism. The service provides personal care and support to up to nine people. At the time of the inspection there were nine people living at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People received person-centred care which met their needs. A plan was in place for the ongoing review of care plans and risk assessments to ensure they reflected the support people received. People were encouraged to be independent and measures were identified to mitigate the risks they were exposed to.

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 felt safe. Systems were in place for reporting and responding to any allegations of abuse. Staff knew how to safeguard people and were confident to raise any concerns. The deputy manager was the identified safeguarding officer for the service.

There were enough staff deployed to meet the needs of people and staff worked flexibly to accommodate this. Staff were recruited safely and received training relevant to their job role to enable them to work effectively. Staff received supervision and appraisal in line with the provider’s policy and staff told us they felt supported by the management team.

Staff were polite and treated people with dignity and respect. The cultural needs of people were considered in the planning of care and individuals were involved and consulted in how they wanted support to be delivered. Systems were in place to communicate information to people in a way to maximise their understanding.

People were encouraged to be independent and links were established with the local community. Opportunities were available for people to engage in a range of activities and social events of their choice. Relevant referrals were made to health and social care professionals and staff followed their advice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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 23 August 2018) and there were breaches of good governance and safe care and treatment. 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

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.

Victoria House 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. The home is registered to provide support for up to nine people over two floors. It is a single home converted from three terraced houses. Residential care is provided for people with a learning disability, physical disability or those with an autistic type condition. Nursing care is not provided at the home. On all three days of the inspection there were nine people using the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Registering the Right Support CQC policy

The home had a registered manager who had been registered since May 2017. 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.

Staff were aware of safeguarding issues and were confident about reporting any concerns around potential abuse. The home was working actively with services on issues external to the home. Monitoring was in place with regard to people’s financial affairs.

Checks were carried out on the equipment and safety of the home. The majority of checks carried out on systems and equipment were satisfactory. However, on the first day of the inspection we found upstairs rooms did not have window restrictors fitted. By the second day of the inspection this had been rectified. A risk assessment with regard to legionella was planned to be completed by the end of the month. Fire drills were undertaken at the home, although we noted none had taken place during the night shift. By the second day of the inspection the deputy manager had undertaken fire drills later in the evening and had also worked with the local Fire Service on a new fire plan for night staff. Personal emergency evacuation plans were not always detailed but contained information specific to the individual’s support needs.

People’s care plans contained risk assessments linked to their individual care plans. However, it was not clear how the levels of risk had been arrived at. We also found some areas of risk were not comprehensively covered or the level of risk did not reflect that detailed in local authority review documents. The home was maintained in a clean and tidy manner.

People and staff told us they felt there were enough staff on duty. Staff told us they were able to accompany people to access the community and support them with their personal care needs. Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience.

Medicines at the home were managed appropriately. Medicines were safely stored and regular checks were made on stock levels and administration. Staff had received training with regard the safe handling of medicines.

Staff had an understanding of issues related to equality and diversity and what it meant for people using the service. They told us they had access to a range of training and updating and records confirmed this. They confirmed they had access to regular supervision and an annual appraisal and records supported this.

People were always supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People had given consent for staff to enter their rooms and to support them with medicines. Day to day consent was sought by staff.

People had been supported to access health care services to help maintain their physical and psychological wellbeing, including health monitoring appointments. People were supported to access adequate levels of food and drink.

Parts of the home had been redecorated and updated and overall the decoration was of a good standard, and provided a homely atmosphere. People had been able to make individual choices about the decoration of their rooms.

People told us they were happy living at Victoria House and we observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Staff displayed a good understanding of people as individuals and treated them with dignity and respect. There was some evidence people had been actively involved in the development of their care plans, although this was less clear with regard to monthly reviews. Professionals told us staff ensured people’s views were noted. A monthly ‘residents’’ meeting took place where people could express their views.

There was some evidence people’s needs had been assessed, although the home relied mainly on local authority assessments. The deputy manager told us people were also assessed when they visited the home initially. Some care plans had detailed information for care staff to follow. Other care plans lacked specific detail about how to support people or had not been updated to reflect recent professional advice. Reviews of care plans were not always appropriately detailed or effectively recorded. People were supported to attend various events and activities in the local community, work placements and holidays. Activities also took place within the home and people clearly enjoyed these.

The provider had a complaints policy. No formal complaints had recently been received. People told us they had no complaints.

Regular checks and audits were carried out by the registered manager and deputy manager. Where actions where noted these had been detailed and actively followed up. However, these checks had not highlighted the issues identified at this inspection, although the deputy manager told us action would be taken to address any issues highlighted.

Staff were positive about the registered manager and deputy manager. They told us they were well supported in their roles. Professionals were also positive about the management of the home. With the exception of those previously noted records at the home were of a high standard and had good detail.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the Safe care and treatment and Good governance. You can see what action we told the provider to take at the back of the full version of the report.