This unannounced inspection took place on 6 June 2018. Victoria Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Victoria Care Home is registered to accommodate up to 93 people in two buildings, divided into four units. The Camelot unit provides residential care. Lancelot unit provides residential care to people with dementia. Guinevere unit provides nursing care. Champion Crescent and Flats provide support for people with an alcohol related brain injury. During our inspection, 57 people were using the service.

The service had a registered manager at the time of our visit. 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.

At our last inspection in December 2017 we identified improvements were required to ensure the quality and safety of people’s care at the service. For example, people were not always kept safe from abuse or avoidable harm; people rights were not protected under the Mental Capacity Act 2005 and complaints were not always captured or responded to appropriately. We found multiple breaches of Regulations. The service was rated as Inadequate.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. Following the last inspection, we met with the provider to confirm what they would do and by when to improve the quality and safety of the service. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. Following this inspection the service was rated as Requires Improvement.

Risks to people’s health and safety had been assessed. However, further improvements were required to ensure that equipment people needed was provided in a timely manner and sufficient guidance about how to keep people safe was provided to staff. People were supported by sufficient amounts of staff who had been recruited safely. Staff understood their responsibility to protect people from the risk of abuse and what action to take if they suspected abuse. People received their medicines safely and lived in a clean home.

People were supported by staff who received training and support. An assessment of people’s needs was carried out before they moved to the home. People were supported to eat and drink and the advice of external health professionals was sought when needed. People lived in a building which met their needs. 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 home supported this practice.

People were supported by staff who were kind and compassionate. Staff knew people well and took time to understand their needs and wishes. People were involved in planning and reviewing their care and had access to independent advocacy. People could be assured that their privacy and dignity were respected by staff.

People received care and support in line with their preferences. Care plans contained guidance for staff about people’s needs and how these should be responded to. A range of activities were provided for people at times to suit them. People were provided with opportunities to make a complaint about their care and complaints were responded to appropriately. Staff were provided with information about how people wished to

This unannounced inspection took place on 11 and 12 December 2017. Victoria Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single packages under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Victoria Care Home accommodates up to 93 people in two buildings, divided into four units. The Camelot unit provides residential care. Lancelot unit provides residential care to people living with dementia. Guinevere unit provides nursing care. Champion Crescent and Flats provide support for people with an alcohol related brain injury. During our inspection, 76 people were using the service.

There was no registered manager in post at the time of our inspection; the previous registered manager had left the service in September 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An interim manager had been in post since September 2017 and they were in the process of applying to register with the CQC.

At the last comprehensive inspection of this service on 20 December 2016, we asked the provider to take action to make improvements to the governance of the service. Sufficient improvments were not made and during this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were at risk of unnecessary harm. Systems in place to protect people from the risk of abuse or improper treatment were not effective. People were not always protected from risks associated with the premises or the improper use of equipment. People were not always protected from risks associated with their care and support. People were not always supported by sufficient amounts of staff and staff were not always recruited safely. People could not be assured that the management of medicines was safe and that equipment used was clean.

People’s rights under the MCA were not always protected as the Act had not always been applied to ensure that decisions were made in people’s best interests. People could not be assured that staff had the skills and training they needed to meet people’s needs in an appropriate way. People did not always get the support they required to eat their meal in a safe way and records did not show that people were always supported to drink a sufficient amount. People had access to health professionals, however, information in care plans about the support people required to maintain good health was not always clear. Although the premises had been adapted to the needs of people living there, improvements were required to ensure that equipment and safety measures were used appropriately.

People told us that most of the staff at Victoria Care Home were caring although some staff did not always display a caring attitude. Our observations supported what people had told us. People’s privacy and dignity was not always respected. People had access to advocacy services.

People were at risk of receiving inconsistent support which was not always personalised to their needs. People’s care plans contained limited information about how staff should support them in line with their preferences at the end of their life. People were supported to take part in some activities and social opportunities although at other times people were provided with little stimulation. Improvements were required to ensure that people’s concerns and compl

This focused inspection took place on 1 March 2017 and was unannounced.

Victoria Care Home is located in Worksop, Nottinghamshire, and provides nursing and residential care for 93 people. At the time of our inspection, 79 people were using the service which is divided into four separate units. The Camelot unit provided residential care, the Lancelot unit also provided residential care and support for people with dementia. Nursing care was provided in the Guinevere unit and Champion Crescent provided support for people with an alcohol related brain injury.

The service 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.

We carried out on unannounced comprehensive inspection of this service on 20 December 2016. Breaches of legal requirements were found and we issued a warning notice in relation to one of these breaches. We asked the provider to take action to ensure that the service was responsive to the needs of the people who lived there.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria Care Home on our website at www.cqc.org.uk.

Action had been taken update care plans and to reinforce the need for clear recording with staff.

People’s care plans contained detailed information which provided clear guidance to staff although further improvements were required to ensure these were reviewed when people’s needs changed. We found that staff were aware of people’s needs and any recent changes.

This inspection took place on 20 December 2016 and was unannounced.

Victoria Care Home is located in Worksop, Nottinghamshire, and provides nursing and residential care for 93 people. At the time of the inspection, 83 people were using the service, which was divided into four separate units. The Camelot unit provided residential care. Lancelot unit also provided residential care to support people living with dementia aged over 65 years. Nursing care was provided in the Guinevere unit which also catered for people with higher dependency needs and short term care placements. Champion Crescent catered for people with an alcohol related brain injury in supported living flats.

The service 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.

People’s medicines were stored and handled safely. Although there were enough staff to ensure people were safe, we observed people's immediate care needs were not always anticipated and responded to. Risks were assessed, but these risk assessments were not always updated. Any accidents and incidents were investigated so that steps could be put in place to avoid reoccurrence, but the mitigating measures were not always implemented or used. The staff understood their role in keeping people safe. People who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse.

Staff had received the training and supervision they needed to support people effectively, although some people did not have confidence in the ability of the staff that supported them.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected.

People told us the food was good and they were able to choose what they ate.

People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

People were supported by staff in a respectful, kind and caring way, but interactions with staff tended to be task related and there was little social interaction. Staff did not always act to promote peoples dignity, although they respected their privacy and encouraged people to be independent. People had access to independent advocacy services. There were no restrictions on friends and relatives visiting.

The service did not always respond to people’s changing needs. Care plans were not consistently updated to take account of peoples changing needs. There were not always full records of the support people had received to be sure that they had received the care that they needed.

People were able to participate in group activities or to spend time on their own pursuing their hobbies and interests if they preferred. Trips out of the home were organised.

A complaints procedure was in place and people felt comfortable in making a complaint if needed.

Auditing and quality monitoring processes were in place, but these were not sufficient to identify the issues we have found during our inspection. There was a positive atmosphere within the home and people’s views were considered when making decisions to improve the service. People spoke highly of the registered manager.

An expert advisor accompanied us on our visit and undertook an audit of the cleanliness and infection control measures in place at the service.

Due to the complex needs of some of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider and we considered information from our last visit on the 12 October 2013. During the visit we spoke with six people who lived at the service, four care workers and a qualified nurse. We also spoke with the acting manager, the deputy manager, the operations director and the head of clinical governance.

We looked at some records including staff training, rota’s and cleaning schedules. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We observed the home was clean and free from any unpleasant odours. We saw that the decorating schedule had continued since our last visit in October 2013 and the corridors were bright and cheerful with people’s doors painted in bright colours to help them orientate themselves.

Staff morale appeared to have improved since our last visit and we observed staff working with people in a cheerful and respectful manner. Staff were welcoming to us and remained helpful throughout the visit.

People who used the service told us, “I have lived here for three years and have always been happy and contented.” Also, “The staff go out of their way to please me and long may it continue.”

We saw that there were sufficient numbers of suitably trained and experienced staff to meet people’s needs.

We carried out this inspection on Saturday 12 October 2013, in response to concerns raised with us by colleagues from the local authority and health services.

We visited Victoria Care Home with a representative from the Bassetlaw Clinical Commissioning Group and a Marketing and Development officer from Nottinghamshire County Council.

We undertook a partial tour of the building, focussing on clinical areas and bathrooms.

We spoke with six members of staff, two residents and one person who was visiting a relative who lived at the home. We also spoke with the person who took responsibility for the service on behalf of the provider organisation. (Nominated Individual or NI).

Our colleagues from health and the local authority also undertook a partial tour of the home and spoke with a variety of staff members, people living at the service and visitors to the service. They provided a separate report for the provider.

We found the premises were suitable for their use and people were in safe, accessible surroundings that were being continually maintained. Staff we spoke with told us a lot of refurbishment and re-decoration had taken place and would be continuing.

A relative told us “I’ve never had problems with cleanliness when I’ve visited. My relative is always well cared for and wears clean clothes. Their room is clean and tidy.”

However, we found that in some areas of the home there were unpleasant odours. This had been identified in the infection control inspection carried out in July 2013 and we felt the provider had not taken the necessary action to resolve this.

Prior to our visit we reviewed all the information we had received from the provider and from other organisations.

During the visit we spoke with four people who used the service and one relative and asked them for their views. We also spoke with two care workers, a registered nurse, the deputy manager and the registered manager.

The manager told us that the home had introduced an opportunity for people to meet informally with the manager over a cup of tea. This was referred to as ‘Tea with the manager.’ This took place each week and people were invited to sit with the manager in small groups to enable them to discuss things on an informal basis.

We also looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff.

We undertook a partial tour of the building to observe care practice and general cleanliness.

A relative told us, " I can’t praise the home highly enough. Of course I was very apprehensive when my relative first came into care but they settled in well and like living here.” And “They are very independent and always say what they want and how they want to be looked after. The staff respect their wishes.”

Prior to our visit we reviewed the information we had received anonymously. We visited one area of the home that had been highlighted in the anonymous information.

During the visit we spoke with five people who used the service and one relative and asked them for their views. We also spoke with four care workers, a domestic assistant, the registered manager, the Head of Clinical Governance and the Director of operations. We looked at some of the records held in the service including care files for five people. We observed the support provided by staff to the people who used the service.

We found people received care and support that met their needs. A person told us,” I am cared for really well and cannot imagine where I would be without them”

We found people were safeguarded from abuse. A relative told us, “I have never seen anything untoward or any poor practice.”

We found the provider had taken steps to ensure there was sufficient and suitable staff available. On the day we visited a member of staff had called in sick and the shift was covered by another staff member who told us that they enjoyed working on the unit and would always agree to cover shifts when possible.

We found the provider had a system to deal with comments and complaints. A person told us, “I would always tell someone if there was anything wrong."

Staff told us they would report anything of concern and trusted the unit manager and the home manager to deal with their concerns.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with nine people who used the service and three relatives and asked them for their views. We also spoke with eight care workers, the deputy manager and the registered manager. We also looked at some of the records held in the service including the care files for seven people. We observed the support people who used the service received from staff and carried out a tour of the building.

We found people gave consent to their care and treatment and received care and support that met their needs. A person told us, ”They (staff) know they are doing well. They always ask if I am alright. I like it here.”

We found people were safeguarded from abuse. A relative told us, “I have never seen anything untoward or any poor practice.”

We found the provider had taken steps to ensure there were sufficient and suitable staff available. One person told us their only concern was, “There were not enough staff.”

We found the provider had a system to deal with comments and complaints. A person told us, “I would complain if I wasn’t happy, but I am happy.”

Victoria Care Home is located in Worksop, Nottinghamshire, and provides nursing and residential care for 93 people. At the time of the inspection, 83 people were using the service, which was divided into four separate units. The Camelot unit provided residential care. Lancelot unit also provided residential care to support people with Dementia aged over 65 years. Nursing care was provided in the Guinevere unit which also catered for people with higher dependency needs and short term care placements. Champion Crescent catered for people with an alcohol related brain injury in supported living flats.

This inspection took place on the 21 and 22 September 2015 and was unannounced.

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 2008 and associated Regulations about how the service is run.

We found that people were at risk because the provider had not ensured the proper and safe management of people’s medicines. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

We found that people who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse. Staffing levels were based on the assessed need of those using the service at the time to ensure that there were sufficient care staff. These staff had received the training they needed to provide care well and were supported by the leadership at the home, although not all staff had attended safeguarding adults’ training which reduced the level of protection afforded to those using the service.

Risks assessments were in place to identify and reduce the risk to people’s safety. People were asked for their consent before care was given and the Mental Capacity Act 2005 had been considered when determining a person’s ability to consent to each aspect of their support. While some applications required under the Deprivation of Liberty Safeguards (DoLS) had been made, further applications needed to be made for others living at the service in order to reduce the risk of people being unlawfully restricted. People were able to choose what they ate and maintained good links to their healthcare providers if they needed them.

Staff were kind and attentive to the needs of those they were supporting, responding to people’s needs in a timely manner. People were usually treated with dignity and respect, and were included in decisions that affected them and offered choice. However, on some occasions staff did not use respectful terms when referring to the support needs of those they were working with.

People received the care they needed in a way that met their needs. We saw staff provide planned care well and respond to people’s changing needs, although the care records were not always updated. The complaints procedure was available throughout the service and people told us they would be treated fairly and their complaint would be resolved if they spoke out. There were formal and informal ways for relatives to be consulted and to share their views on the service.

Everyone we spoke with had confidence in the leadership of the home who shared clear expectations with the team. There were processes in place to check on the quality of the service, but these lacked action plans to ensure that any shortfalls found were rectified.

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