This was an unannounced inspection that took place on 8 and 11 January 2019.

Victoria House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 provides accommodation for up to 30 older people some of whom may have dementia. It is located in the Kew area of Richmond in Surrey.

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

At the last inspection in November 2017, the key question of well-led was rated requires improvement. The other key questions of safe, effective, caring and responsive were rated good. The overall rating was good. We identified one breach of the regulations regarding the quality assurance system which had not picked up that reviews on the samples of care plans we looked at had not been updated. At this inspection the requirements of this regulation were met.

People said the home had a friendly and relaxed atmosphere with well provided care and support. There were plenty of staff to meet people’s needs and they did so in a respectful, kind and compassionate manner.

The home kept thorough, comprehensive and up to date records that were regularly reviewed with information presented in a clear and easy to understand way.

People were encouraged and enabled to discuss health needs and had access to community based health professionals as required as well as the home’s care staff. People’s diets were balanced, protected them from nutrition and hydration associated risks and also met their likes, dislikes and preferences. Some people said the meals available were of good quality, plentiful and there were sufficient choices provided. Others felt they could be improved. Staff prompted and supported people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy meals.

The home was clean, well-furnished and maintained and provided a safe environment for people to live and staff to work in.

Staff were very knowledgeable about the people they supported and had appropriate skills and training to meet people’s needs competently. They provided people with individualised care in a professional, friendly and supportive way.

Staff were aware of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

The Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) require the provider to submit applications to a ‘Supervisory body’ for authority. Applications had been submitted by the provider, applications under DoLS had been authorised and the provider was complying with the conditions applied to the authorisation.

Staff said the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives said the registered manager and staff were approachable, responsive and they encouraged feedback.

The home had systems that consistently monitored and assessed the quality of the service provided.

The health care professionals that we contacted were very positive about the care and support provided by the home and raised no concerns regarding its quality.

This was an unannounced inspection that took place on 27 and 28 November and 1 December 2017.

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. Victoria House accommodates 30 older people in one adapted building.

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

At the last inspection in December 2015 all the key questions of safe, effective, caring, responsive and well-led were rated good and there was an overall rating of good. At this inspection we have made a judgement of requires improvement for the well led question. This failing represents a breach of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives said the care and support provided at Victoria House was very good and they liked its friendly atmosphere. There were enough staff available to meet people’s needs and the staff were friendly, helpful and attentive providing care and support in a kind and skilful manner.

Most of the home’s records were comprehensive, kept up to date and regularly reviewed with information recorded in a clear and easy to understand way. However the quality assurance system had not picked up some review information that had not been updated on a sample of people’s records. We have made a requirement in respect of this.

People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals when required. They were protected from nutrition and hydration associated risks by balanced diets that also met their likes, dislikes and preferences. People and their relatives said the quality of the meals provided and available choices was good. People were prompted to eat their meals and drink at their own pace.

Victoria House was well maintained, furnished, clean and provided a safe environment for people to live and staff to work in.

Staff were competent and knowledgeable about the people they cared for. They had appropriate skills and training and were focussed on providing people with individualised care and support. This was provided in a professional, friendly and supportive manner. They were aware of their responsibilities to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences. Staff said the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives thought the registered manager and staff were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

This was an unannounced inspection that took place on 1 December 2015.

Victoria House is a care home registered to provide accommodation for older people who require personal care. The service can accommodate up to 30 people and is located in the Kew Gardens area.

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

In July 2014, our inspection found that the home required improvement regarding recording of medicine administered. At this inspection the home met the regulations.

People and their relatives thought the service provided by the home was of a very good quality. They told us that the home had a friendly atmosphere and they and their relatives enjoyed living at Victoria House. They thought there were enough staff to meet people’s needs and found the staff team were skilled, caring, attentive and provided care and support in a kind and friendly way.

The records kept were comprehensive and up to date. They recorded information in a clear and easy to understand way, were fully completed, and regularly reviewed. This meant staff were enabled to perform their duties well. People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals, such as GPs if required. They were protected from nutrition and hydration associated risks with balanced diets that also met their likes, dislikes and preferences. People and their relatives were positive about the quality of the meals provided and available choices.

Victoria House was well maintained, furnished, clean and provided a safe environment for people to live and staff to work in.

The staff we spoke with were competent, knowledgeable about the people they worked with and care field they worked in. They had appropriate skills, training and were focussed on providing individualised care and support in a professional, friendly and supportive manner. Staff said the home’s manager and organisation provided access to good support and there were opportunities for career advancement.

People using the service and their relatives said the management team at the home, were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the CQC which looks at the overall quality of the service.

This was an unannounced inspection. During the visit, we spoke with ten people living at the home, four relatives, one district nurse, five care staff and the registered manager.

In September 2013, our inspection found that the care home was meeting the regulations we inspected.

Victoria House provides accommodation and nursing care for up to 30 people who have nursing or dementia care needs. There were 26 people living at the home when we visited.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us contradictory things about the service they received. Whilst most people we spoke with and their relatives were very happy, others were not. People who weren’t told us that the things they were not happy with were relatively minor. Our observations and corroboration of evidence showed that the care provided was good although some records were not completed. The service was safe, effective, caring, responsive and well led although some of the medicine records required improvement.

Some medicine administration records for people using the service were incomplete. This is a breach of Regulation 13 HSCA 2008 (Regulated Activities) Regulations 2010 Management of medicines. You can see what action we told the provider to take at the back of the full version of the report.

During our visit people told us staff treated them with dignity and respect. This was we reflected in the care and support we saw. People said "A very easy place to be". "Always have a laugh and a joke, but I am treated with respect".

We were told that people using the service and their families participated fully in choosing to move to the home. This was confirmed by the assessment and care plan information we looked at. Someone said "This is for the rest of my life and I wouldn't tolerate anything less than the standard of service I receive here".

People using the service were very involved in the care and support that was delivered and the way that it was provided. One person told us "The people running it know what they are about, don't intrude, are well trained and the particularly good thing is there is something on every day".

They said the type and quality of care they received from caring and competent staff was excellent and they enjoyed living at the home. People commented "I wouldn't have done all the things I have if I was at home" and "I'm so much happier here than living at home".

They also told us that there were enough staff to support them and "Nothing was too much trouble".

They also said that they were aware of the home's complaints procedure but had not had cause to use it.

We found that people living at the home were treated with dignity and respect during the inspection and they and their visitors were treated with courtesy and greeted in a friendly and welcoming way.

The records we saw were up to date, regularly reviewed and people using the service were encouraged to contribute to the way care and support was given to them.

There was a thorough assessment process prior to people moving in and they were encouraged to visit as much as they liked before deciding if they wanted to move in.

There was extensive building work being carried out during the inspection. This was done in an unobtrusive way with as little disruption to people living at the home as possible.

There were suitable staffing levels to provide people with the support and service they needed and wanted.

There was an easily accessible complaints policy and procedure and clear complaint investigation process.

During our visit people told us staff treated them with dignity and respect. This was we reflected in the care and support we saw. One person said "It couldn't be better". We were told that people using the service and their families participated fully in choosing to move to the home. This was confirmed by the assessment and care plan information we looked at. Someone said "This was like coming into a home not an institution. People using the service also shaped the way that care and support was delivered in a style that they wanted. One person told us "I do say to people outside the home that the awful things you hear about care homes couldn't happen here". They said the type and quality of care they received from caring and competent staff was very good and they felt safe receiving the service. People commented "When I needed help it was freely given, you are not ignored by staff" and "Staff really do their best".

They did not tell us about the support staff received from the home or the quality assurance system in place. They did tell us that "There was huge co-operation with the catering manager over the menus we preferred". They also said that the home meetings took place and this was reflected in the meeting minutes we looked at.

There was also a quarterly news letter.

People told us they liked living at the service and that they feel appropriately supported by the staff.

Some people spoke to us about how involved they are in their care planning to ensure they get the support they want.

The atmosphere within the home was relaxed and friendly, with people spending their time as they wished.

People told us that they enjoy the activities provided by the service.