About the service: Victoria House is a nursing and residential care home that was providing personal and nursing care to 29 older people.

People’s experience of using this service:

People felt safe and staff used health and safety equipment safely. People had risk assessments although information about risks to people was not always comprehensive. There were enough staff to keep people safe, but the staffing arrangements did not always provide sufficient time for staff to give person centred care. Medicines were managed safely. Staff followed infection control procedures and received infection control and food hygiene training.

Staff had the skills and knowledge to deliver care effectively and they received good support from the team and the registered manager. Systems were in place to make sure people’s health and nutritional needs were met. People were comfortable in their environment; the provider was improving the décor.

At the last inspection the provider was not supporting people to have maximum choice and control of their lives. At this inspection they had improved how they supported people to have maximum choice and control, but further improvements were required. The policies and systems in the service required further development to support this practice.

People who used the service, family and friends, without exception, provided positive feedback about the service and were complimentary about staff and management. Other professionals told us the service was caring.

The provider was introducing a new electronic care recording system. The transition had created some difficulties which resulted variable care plans. The registered manager was looking at ways of involving people more in the care planning process. People engaged in one to one and group social and leisure activities. During the inspection ‘Friends of Victoria House’ were holding a coffee morning. This was a pleasant and lively atmosphere, and well attended.

Feedback about the registered manager was consistently good. People who used the service and visiting relatives and friends told us they would recommend the service to others.

Quality management systems were in place but these were not always effective because they did not always drive improvement. The provider had not identified some of the issues picked up during our inspection. The registered manager was responsive and where appropriate, took swift action to address shortfalls. They were keen to develop and improve their quality management systems and provide people with consistently high quality care.

Rating at last inspection: Requires improvement. The report was published on 28 April 2018.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to review intelligence about the service and visit again within our recommended return inspection timescales. If any concerning information is received we may inspect sooner.

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

The inspection of Victoria House took place on 13 March 2018 and was unannounced. The home had been rated overall good at the previous inspection in February 2016 but were rated as requires improvement for the safe key question because there was a breach of safe care and treatment due to concerns with medication. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question, safe, to at least good. During this inspection we checked to see if improvements had been made.

Victoria House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Victoria House accommodates 30 people in one adapted building. On the day we inspected 24 people were living at Victoria House.

There was a registered manager in post and they were available during the inspection. 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 told us they felt safe and we saw staff were pro-active in their interventions, such as preventing a person from falling off their chair by encouraging them to move backwards into the seat. Staff knew how to report any safeguarding concerns and any incidents which occurred within the home such as falls or pressure damage, were considered to see how practice could be improved.

Risks were managed well, with regular checks of equipment and the premises. However, some records needed further detail to provide specific guidance for staff in relation to equipment and methodology used.

Staffing levels were appropriate and meant people had their needs met promptly. Medication administration practice was safe and checks were in place to ensure procedures and knowledge were correct.

The registered manager understood what constitutes good practice and led by example. However, they were not always aware of the latest guidance to follow. They reassured us they were in the process of reviving many of the policies and procedures which were out of date.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; however, the policies and systems in the service did not support this practice.

Staff received an induction, supervision and training, however, not all new staff completed the Care Certificate which is accepted best practice for people new to care.

We observed people actively supported with nutrition and hydration needs were met regularly. People and relatives we spoke with confirmed how much emphasis was placed on ensuring sufficient fluid intake. People also accessed external health and social care support as required.

Staff displayed kindness, compassion and interest in the people they were caring for. It was evident they knew people and their relatives very well, sharing high levels of conversation and enabling people to engage with as much as possible around them. Privacy and dignity was respected at all times.

Care records were comprehensive and regularly evaluated. People enjoyed a range of activities at both individual and group level.

The service had not received any complaints but had received many compliments.

The home had a positive, welcoming atmosphere where everyone was acknowledged and felt included. This vision was shared with all staff and led by the registered manager who had strong values. This culture was embedded in practice and culture.

There was a robust quality assurance system in place with evidence of actions being taken promptly where issues were noted. People who lived in their home and their relativ

The inspection took place on 18 February 2016 and was announced. At the last inspection in January 2015 we found the provider was in breach of two regulations, relating to dignity and respect and good governance. We saw the provider had addressed the areas of concern identified at the last inspection.

There was a registered manager in place. 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.

The home was friendly and welcoming and people, staff and visitors reported a homely atmosphere.

Staffing levels were appropriate to meet people’s needs and secure recruitment procedures ensured staff were suitable to work with vulnerable people.

Medications were not always given to people as prescribed and there were some errors in accounting for medication.

Staff understood the Mental Capacity Act and the implications for their work in ensuring people’s rights were promoted.

Staff were motivated and dedicated to their work with people. Staff were supported to carry out their work and they had opportunities for regular training and supervision.

People were central to the work and staff were passionate about caring for them. There was evidence of a good rapport with people and their families.

People’s dignity and respect were maintained at all times in their care and routine.

The activities coordinator knew people’s social histories and engaged with people on an individual basis or in group activities according to their needs.

Care records contained accurate information and regular reviews of care were evident.

People and their relatives knew how to raise a complaint if they felt this was necessary.

The registered manager was visible in the service and knew each person well. People, staff and relatives and visiting professionals said the home was well run and managed.

Systems were in place to monitor the quality of the provision and drive improvement.

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

This inspection was unannounced and took place on 28 January 2015. At the last inspection on 19 June 2013 we found the provider was breaching regulations relating to care and welfare of people who use services, cleanliness and infection control and respecting and involving people. At this inspection we found the provider was still in breach of the respecting and involving people regulation. We also found there was a breach of the assessing and monitoring the quality of service provision regulation.

Victoria House provides accommodation and personal care for up to 30 older people some of whom may also require nursing care.

At the time of our inspection 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 2008 and associated Regulations about how the service is run.

Medicines were administered to people by trained nursing staff. Nurses administering medicines wore a red tabard which indicated they should not be disturbed. We saw the practice was effective.

We reviewed some people’s medication administration records and an incorrect dose of a person’s medication had been administered. We spoke with the nurse who administered the medication who confirmed a drug error had occurred and this would be reported to the relevant organisations.

Staff we spoke with told us they were aware of how to detect signs of abuse and were aware of external agencies they could contact. People who lived at Victoria House told us they felt safe living there. One person said, “I do feel safe here.”

We looked around the communal areas of the home and in some people’s bedrooms. The home was clean and odour free. Bathrooms contained soap dispensers and paper handtowels. There was sufficient personal protective equipment for staff to use including disposable gloves, aprons and hand gel.

We arrived at Victoria House at 7.30am and found 15 people lined up in the main lounge, conservatory and small lounge. 11 of the 15 people were sat in wheelchairs with little stimulation. When we asked staff why this was we were told they were waiting to be taken into the dining room for breakfast which was at 8am.

People generally had a good choice of food, however, we saw one person being supported to eat food which was pureed and looked unappetising. We were unable to identify what the food was. The chef told us the meal was the same as everyone else’s but just pureed.

We noted two toilets on the ground floor for the use of people living at the home. The toilets were not large enough for them to be accessed easily by wheelchair users, the provider had improvised by adding external curtains which were drawn when the toilets were in use. However, the door was left open which did not maintain people’s privacy and dignity.

Staff with whom we spoke said they had received training in the Mental Capacity Act 2005 (MCA) and specifically on the Deprivation of Liberty Safeguards (DoLS). Care staff demonstrated a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

The provider had a comprehensive training programme in place. We saw the training matrix which detailed the dates of staff training; this ensured the registered manager knew when staff should attend refresher training.

During the day we observed some good caring practices. Staff always took the time to speak with people living at Victoria House and pass the time of day with them. One person we spoke with told us, “They treat me kindly and speak to me nicely.”

We spoke with six people who used the service who said they had little choice in their daily routines. One person said, “I have no choice in where I sit, they just bring me in here.”

We looked at three people’s plans and found them comprehensive and easy to navigate. Care plans were written in a person centred way and a full assessment of people’s care needs had been carried out prior to them moving to Victoria House. They contained up to date information based on people’s current health requirements.

Quality assurance systems in place in the home to monitor whether the service was providing high quality care were not robust.

People who used the service and staff all spoke very highly about the registered manager of the service. One member of staff said, “I feel very supported by the manager and everyone else working here.”

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

We carried out this inspection as we had received some information of concern.

We found that there were sufficient staffing levels through the day time but there were issues around the early morning staffing levels.

We found that there was a lot of activity within the home during the early morning with peoples’ lights being turned on and staff conversing with them. We saw that televisions and music were playing whilst staff were carrying out their duties.

We observed people sleeping in the lounge area and when we discussed the reasons for this with people and staff we found that this was due to poor management of care.

We found the communal areas of the home to be clean in appearance, however there were odours in some of the bedrooms.

We saw that people were well cared for during the daytime and saw recognition of the care people received through thank you cards displayed in the entrance area.

We spoke with the relatives of two people who were happy with the care being provided. Comments included:

“They just do a good job really.”

“Staff are lovely, all really nice.”

People using the service say they are happy and like living in the home. Visiting relatives say they are happy with the care and support provided. One person said they are pleased they came to the home as it is like living in a hotel. They said the carers are excellent the food is very good and they have everything they need. Another person says the Victoria House is very good and they are glad to be living in the home.

People using the service said they are very happy and if they have any concerns they would talk to the care staff. People also said they feel safe and well cared for. One visiting relative says their relative is very happy and well cared and safe. They went on to say Victoria House is a really good place to be.

People said they like living in the home. One person said they like their room they have everything they need. One visiting relative said the home is always clean and their relative is comfortable and well cared for.

People living in the home said they like the carers as they listen to what they say and are polite and courteous at all times. One visiting relatives says the staff are excellent and they couldn’t ask for better care.

People said they like the staff caring for them. One person said the carers are lovely and you couldn’t ask for better care. Another says the staff are very good indeed and are always ready to help you if you need anything. Two visiting relatives said the staff are excellent and they have never had any issues regarding the services and care provided.

We observed people relaxing around the home and those supporting them looked confident and comfortable in their work.

People said they are asked if they are happy with the care and services provided. Two visiting relatives said that they get a satisfaction questionnaire every year to complete and they have never had any issues about standards in the home.

People living in the home said if they have any complaints they tell the staff and things are sorted out right away

Two visiting relatives said they had no issues and felt that people are well cared for and if they had any complaints they felt confident that they would be dealt with.