About the service:

Victoria House is a residential care service providing personal care and accommodation for up to six people living with a learning disability. At the time of our inspection six people were using the service.

People’s experience of using this service:

• The service was not always clean. We recommended the service ensure there were systems in place to prevent the risk of infection.

• The service did not record and learn from accidents and incidents. We recommended the service follow best practice guidance and demonstrate a culture of continuous improvement.

• People's risks were not always assessed to ensure staff could provide adequate care and support. We recommended the service assessed people’s risks to ensure risks was mitigated.

• People were protected from potential harm and abuse.

• There were enough staff to provide support and staff had been recruited in a safe manner.

• People received their medicines in a safe way.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service did not support this practice. We recommended the service review their systems to manage this in line with best practice.

• The service was adapted to meet the needs of people living in the service.

• The service supported people to maintain a healthy lifestyle and access support from other health and social care professionals.

• Staff were provided with adequate training and support to provide effective care.

• People received support that was caring and met their needs.

• People were supported to be independent and their privacy and dignity was respected.

• People and their relatives were involved in their care package and knew how to raise a complaint.

• The quality assurance systems in place did not identify the shortfalls we found during our inspection. This demonstrated a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, ‘Good Governance.’

• People and their relatives spoke positively about the registered manager and the service worked well in partnership with others to improve the quality of care provided.

Rating at last inspection:

At the last inspection the service was rated Good, (published: 1 September 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

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

This unannounced inspection took place on 6 and 7 July 2016.

Victoria House is a six bed service providing support and accommodation to people with learning disabilities. At the time of the inspection six people were living there.

The service has 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 and associated Regulations about how the service is run.

People were safe at the service. They were supported by kind, caring staff who treated them with respect. Strategies were in place to minimise risk and enabled staff to support people as safely as possible both in the community and in the service.

People were protected by the provider’s recruitment process which ensured staff were suitable to work with people who need support.

People lived in a clean environment that was suitable for their needs.

Staff supported people to make choices about their care. Systems were in place to ensure that their human rights were protected and they did not have any unnecessary restrictions place on them and were not unlawfully deprived of their liberty.

People were encouraged and supported to maintain their independence and develop their skills. They were involved in activities of their choice and had varied and personalised activity programmes.

People received a person centred service. They were supported to make choices and to have as much control as possible about what they did. People and their family members were consulted and involved in reviewing the support they received.

Staff were clear about their roles and responsibilities and received effective training, guidance and support from the registered manager. This provided them with the knowledge, skills and confidence to meet people’s complex needs.

The service was robustly monitored by the registered manager and the provider to ensure that people were receiving a safe and effective service that met their needs and wishes.

The staff team worked closely with other professionals to ensure people were supported to receive the healthcare they needed.

Systems were in place to ensure people received their prescribed medicines safely.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:-

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

We met four of the five people who used the service and observed how they were supported by the staff. After the visit we spoke to three people's relatives. We saw that staff treated people with respect and dignity. Relatives told us that they were very happy with the service provided. They said people were safe and well cared for. One relative told us “yes he is safe there and they keep him safe when they are out."

Staff had received training to ensure that they supported people safely and appropriately. People’s individual files indicated the risks to the person and how these could be minimised to ensure that they were supported as safely as possible.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and staff had received this training.

The building was appropriately maintained and serviced to ensure that people lived in a safe environment. A relative told us “the building is in good shape.”

Is the service effective?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We saw that as part of a quality assurance questionnaire a relative had commented “due to the love and care X receives disruptive outbursts appear to be receding and they are more positive and relaxed.”

A relative told us “they look after X’s health issues.” Each person had a detailed current health action plan which included a record of medical appointments and outcomes and any other health issues. There was a stable staff team and they were able to recognise if people were unwell or in pain and took the necessary action.

People's care needs were assessed and detailed plans of care developed from these. Staff had a good understanding of how to meet people's individual and assessed needs and of individual preferences.

Is the service caring?

Relatives we spoke with were very positive about the care provided by the staff team. We saw that as part of a quality assurance questionnaire a relative had commented “the home is run to an excellent standard with loving and caring staff.” We saw that staff supported people in a gentle, respectful and kind way. They offered people choices and talked to them about what was happening or what they needed to do.

People's preferences and diverse needs were recorded and care and support was provided in accordance with this. Their religious, cultural and social needs were identified and addressed. Some people went to church and food from different cultures was provided. They were also supported to be part of the wider community.

Is the service responsive?

Care staff we spoke with were knowledgeable about the needs of people they supported and how to meet them. They told us how they identified if a person was unwell or unhappy and the action that they took if this occurred.

The service was responsive to people’s changing needs and wishes. We saw that care plans included information about people's likes, dislikes and preferences and which were reviewed and updated at least every six months to ensure that they had correct information about people’s needs and how these should be met.

Is the service well led?

The service had a registered manager in place and a clear management structure. Staff told us the home was well managed and they received the support and guidance that they needed to carry out their duties.

The provider had a number of different quality assurance systems in place to enable them to effectively monitor the quality of care provided. The manager carried out monthly ‘managers audits’ and any issues were documented and followed up. The provider also visited monthly to monitor the quality of the service and to check that any identified issues had been addressed.

People’s care, health and welfare needs were being met. They were happy with the quality of care that they received. One relative told us “I can recommend Victoria House to anybody. My son is very happy there and they look after his health needs.” There were systems in place to ensure that people received their prescribed medication appropriately.

We found that there were sufficient staff on duty to meet people’s needs and both staff and relatives confirmed this. A relative told us “yes there are enough staff. Each time I go there I see three staff and I don’t think it’s necessary for them to have more. They must know what they are doing as I have absolutely nothing to complain about.”

People had confidence that if they were not happy about anything the manager would address this. One relative said “if I had a complaint I think they would cooperate with me and sort it out.” People were protected from the risks of unsafe or inappropriate care because accurate and appropriate records were maintained.

During the course of our inspection we met and spent time with three of the people who use the service. One person talked to us about what they did, what they liked and about Victoria House. The other two people did not want to speak to us but we were able to observe what they were doing and how they interacted with the staff. We also spoke with three relatives. All those we spoke with were happy with the care and support provided by the service. We saw that people who use the service and staff spent time together doing different things and chatting to each other. People were treated with respect by staff and were relaxed in their company.

A person who uses the service said, “I am happy here. I like to go to college and to the farm.” A relative told us, “We are happy with Victoria House and think that our son is well looked after. The others all seem happy as well.”

We spoke to three of the staff who were on duty. One said, “The home has changed for the better. There are far more activities and people are more involved in the community. For example, they participate in voting. There are no incidents now and people are happy with what they are doing. There is a consistent staff group and it is like a family. I come to work with a smile. It's much more relaxed here now and they are all very safe. I have no concerns.” Another said, “The home itself looks much better and is much more homely. The clients are happy. They have what they want. They are more independent now and they have choices. They have a choice to do what they like. They can choose where to spend their time. I am very happy with the way things are going.” The third member of staff told us, “There is a good team and the service users are lovely. They get everything they need and want. Activities, socialising or eating out. There are risk assessments for everyone and we do health and safety checks and have various guidelines. We assess things before we do them and that helps to keep people safe.”