We carried out an unannounced comprehensive inspection of this service in November 2015. Breaches of legal requirements were found and we rated the service as “requires improvement”. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. On this inspection we found that the provider was no longer in breach of the regulations.

This inspection took place on 30 January 2017 and was unannounced.

Victoria House is registered to provide accommodation for personal care for up to 20 older people or people living with dementia or a physical disability. There were 12 people living at the service on the day of our inspection.

The service was managed by the registered provider. Registered providers are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment. Six people living at the service had been referred to the local authority DoLS team and were waiting on assessments to have their freedom lawfully restricted under a DoLS authorisation.

Staff undertook appropriate risk assessments for all aspects of a person’s care to keep them safe from harm. Care plans were developed to support people’s individual needs. Staff knew what action to take and who to report to if they were concerned about the safety and welfare of the people in their care. People received their prescribed medicine safely from staff that were competent to do so. The provider ensured that there were always sufficient numbers of staff on duty to keep people safe.

People were supported to have a healthy and nutritious diet and hot and cold drinks and snacks and fresh fruit were available throughout the day. People had their healthcare needs identified and were able to access healthcare professionals such as their GP and dentist. Staff knew how to access specialist professional help when needed.

People were at the centre of the caring process and staff acknowledged them as unique individuals. People who lived at the service told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect. People were cared for by staff that were supported to undertake training to improve their knowledge and advance their skills to enable them to perform their roles and responsibilities effectively.

People were supported to have an active life and were encouraged to take part in hobbies and interests of their choice. However, there was not an activity coordinator in post. Relatives commented that their loved ones were well looked after.

People where able, were supported to make decisions about their care and treatment and maintain their independence. People and their relatives had access to information about how to make a complaint. Relatives told us that they could approach staff with concerns and knew how to make a formal complaint to the provider.

The provider had introduced robust systems to monitor the quality of the service and make improvements. Staff had access to professional development, supervision and feedback on their performance. People, their relatives and staff found the provider and their deputy approachable.

Overall, we found that the provider had led their team to introduce and sustain improvements to the service, such as good infection control practices and monitoring the quality and safety

The inspection took place on 9 and 10 November 2015 and was unannounced.

Victoria House is registered to provide accommodation and personal care for up 16 older people. There were 13 older people or people with a dementia type illness living at the service on the day of our inspection.

The service was managed by the registered provider. Registered providers are ‘registered persons’. Registered persons have the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect them. The management and staff understood their responsibility and made appropriate referrals for assessment, but no one at the time of our inspection had a current DoLS authorisation.

The provider was not meeting the requirement of the regulations with regard to assessing and monitoring the quality of the service, cleanliness and infection control and safe staffing levels.

Standards of cleanliness were not always maintained throughout the service and there was a risk of cross contamination from soiled and damaged equipment.

People received their medicines safely but not always at a time that was convenient to them. Staff were aware of safeguarding issues and knew how to raise concerns with the registered provide, but were unaware of the local safeguarding authority.

People were cared for by staff that were not always supported to undertake training to improve their knowledge and skills. Staff did not always receive feedback on their performance through supervision and appraisal

People were provided with regular meals. People were able to access healthcare professionals such as their GP and district nurse.

People and their relatives told us that staff were kind and caring. However, we found that people were not always involved in making decisions about their care. People did not always have their right to their personal space respected.

People were not always enabled to follow their hobbies and pastimes and were not supported to maintain their independence. Some relatives felt that their loved ones were bored. Staff provided care centred on tasks rather than the person.

People, their relatives and staff found the provider approachable. The provider did not have systems in place to monitor the effectiveness of the care and treatment people received. The provider was not meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

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

At our last inspection on 24 May 2013 we found that although there was a good overall standard of cleanliness in the home, it did not have infection control policies in place.

At this inspection we saw the home had policies in place which were clearly displayed. We saw disposable cloths were available to the housekeeping staff.

At the previous inspection we noted the cleaning rota was written on a scrap piece of paper and was not formalised. At this inspection we saw a cleaning schedule on display in the laundry.

We did not speak to people using the service about this outcome area. This was because we only required to look at records and speak to staff on this visit.

As part of our inspection we spoke with a number of people who use the service. They spoke positively about the care and support they received. They told us they liked living in the home and confirmed that they were supported to make choices and decisions about the care they received.

Comments included, " Girls are looking after me", "I can have a bath when I want one", "I feel safe" and " I know when I press my call bell this will be answered."

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this we used a formal way to observe people in this review to help us understand how their needs were supported. We call this the Short Observational Framework for Inspection (SOFI).

Throughout this observation we saw all staff treat people with respect and courtesy. We saw positive interaction between staff and people using the service.

Care and treatment was planned and delivered in such a way that was intended to ensure people’s safety and welfare. We looked at three care plans for people who used the service. These were personalised and provided detailed guidance about how people’s needs should be met.

Care plans included a personal profile for each person ‘Remember I’m Me’ which provided members of staff and visitors with information on each person’s social and occupational history as well as information on their preferred daily routines, what type of bedding was preferred, and their spiritual and cultural needs.

We were present whilst lunch was taken. We saw appetising food was served. People who needed assistance to eat their meal were helped by individual members of staff sitting with them.

One care worker commented, “The food is good, everything is home cooked and prepared well.” One person who lived at home told us, “The food is very nice, I never go hungry.”

We found the building had been maintained effectively. The standard of decor was good. We saw the carpets and laminate floors in communal areas and in people’s rooms were clean and in good condition.

We asked one member of staff for their opinion on the staffing levels, they said, “The staffing is fine, we never have a problem. One person told us, “We are very well looked after, nothing is too much trouble. Another person commented, “The staff are exceptionally friendly.”