The last inspection took place on 1 September 2015 when this service was rated as ‘good’. This inspection took place on 8 November 2017 and was unannounced. We found the service continued to be good in four of the key questions. Some improvements were identified in relation to the key question of Safe. The provider had recognised there had been a decline in some standards at the home following our last inspection and had acted upon these to ensure the home continually improved.

Victoria Manor 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. The care home provides personal care, including for those living with dementia, and accommodates up to 30 people across two floors. There were 26 people living in the home at the time of our inspection.

There was a registered manager in post. 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 registered manager had been in post since June 2017 and was registered with us in August 2017.

People told us they felt safe living at Victoria Manor and there were systems and processes to protect people from the risk of harm. Staff knew how to manage risks associated with people’s care and to report any concerns to the registered manager. There were enough staff available to support people’s needs but we received varying views of the effectiveness of staff, partly due to the number of agency staff used in the home.

There was a procedure to manage people’s medicines but this was not consistently followed to ensure medicines were managed safely.

The environment had been adapted to take into account people’s physical needs and to support people’s dementia. There was a process to undertake safety checks of the environment and equipment although we identified some hot water pipework that had not been covered to minimise the risk of burns to people. The home was clean and staff understood what was expected of them to maintain good infection control practice within the home.

Staff received training in areas considered essential to meet people’s needs safely and consistently, and there were enough suitably trained staff to meet people’s personal care needs.

New staff received an induction to the home that helped them to understand the individual needs of the people who lived there.

Staff had a working knowledge of the Mental Capacity Act and understood the need to ensure people consented to care before this was provided. Where restrictions on people’s liberty had been identified, Deprivation of Liberty Safeguard (DoLS) applications had been made to the local authority.

Staff were caring and considerate in their approach to people and did not rush people when supporting them. They understood the need to respect people’s privacy and dignity and to give people choices about how they spent their day. People had access to some social activities of their choosing and were also able to participate in group activities. We saw positive engagement between people and staff. The activity co-ordinator (referred to as wellbeing co-ordinator) post was vacant at the time of our visit.

People were provided with a choice of meals and these looked hot and appetising. Snacks and drinks were provided throughout the day to maintain people’s nutritional needs.

People accessed healthcare professionals when needed. A GP visited the home each week and people were also supported to attend regular health checks to maintain their physical and mental health.

Staff were positive about working at the home and felt sup

This inspection took place on 1 September 2015. It was an unannounced inspection.

Victoria Manor provides accommodation with personal care for up to 30 people. There were 22 people living in the home at the time of our inspection. The majority of people living at Victoria Manor were living with dementia.

There was a registered manager in post. 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 living at Victoria Manor. The registered manager and staff understood their responsibilities to keep people safe. There were systems and processes to protect people from the risk of harm. These included a procedure to manage identified risks to people’s care and an effective procedure for managing people’s medicines. There were enough suitably trained and experienced staff to meet people’s personal care needs. Care staff were much busier in the late afternoon and were unable to meet people’s social needs at that time.

Staff received training in areas considered essential to meet people’s needs safely and consistently. New staff received an induction to the home that helped them to understand the individual needs of the people living there.

Staff understood about consent and where people had capacity to make decisions, staff respected decisions people had made. Where restrictions on people’s liberty had been identified, the registered manager had made the appropriate Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

Staff were caring, courteous and respectful when engaging with people. People were given choices about how they wanted to spend their day so they were able to retain some independence in their everyday life.

Food looked hot, nutritious and well-presented. People confirmed they enjoyed their meals and were given a variety of snacks and drinks through the day. People were supported to attend regular health checks to maintain their physical and mental health.

There was a variety of activities available to meet people’s social needs, but there was little to stimulate people who chose not to join in. The registered manager had plans in place to improve the environment within the home to provide further stimulation and engagement for the people living there.

Staff said the home was well managed and the registered manager was very supportive and encouraging. There were processes to capture the views of staff about the service and staff told us they felt listened to. People living in the home had some involvement in making decisions about staff recruitment.

There were systems in place to assess and monitor the quality of the service. This was through feedback from people who used the service, their relatives, staff meetings and a programme of checks and audits.

When we visited Victoria Manor in April 2014, we identified some concerns around care and welfare, the management of medicines within the home and the systems in place to monitor the quality of service provided. The provider subsequently sent a plan setting out the actions the service was taking to ensure improvements in these areas. On 27 August 2014 one inspector, a pharmacy inspector and an expert by experience visited the home to check the actions had been implemented.

During our visit we spoke with the manager, deputy manager and two staff members. We also spoke with eight people who used the service and two visiting relatives.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We looked at how the service stored and managed medicines. The Deputy Manager told us that there were safe systems for medicine management in operation. This included undertaking regular checks on medicine records to identify any problems and to ensure staff followed safe medicine procedures. At this inspection, we found arrangements were in place to ensure medicines were managed safely.

One person told us, "I have a lovely life and feel safe here." Another person told us, "I feel safe here. They are quite nice to us."

Is the service effective?

We found improvements had been made to the environment and there was a calm and relaxed atmosphere within the home. Sensory materials had been introduced to provide stimulation and interest to people, especially those living with dementia. The activities co-ordinator was liaising with other services to provide a programme of activities to engage people.

Is the service caring?

People told us they were treated with dignity and respect by staff. One person told us, “The staff are very kind, they often sit and talk with us. They are nice people.”

Is the service responsive?

Where people had behaviours that challenged others, staff had the information they needed to support them in maintaining the person’s dignity and reduce any potential upset to other people.

Is the service well led?

Incidents and accidents were recorded so they could be monitored to identify any emerging patterns or trends so action could be taken to reduce the risk of them occurring.

One staff member told us, "I'm able to speak with the management at any time about anything, they are very good."

The inspection team who carried out this inspection was made up of two inspectors and an expert by experience. We spoke with the deputy manager, two members of staff and a quality assurance manager from the provider group. The registered manager was on leave at the time of our inspection. We also spoke with a visiting healthcare professional to the home. Speaking with these people helped answer our five questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive and is the service well led?

Below is a summary of what we found. This summary is based on our observations and evidence we found during the inspection. We were able to speak with eleven people who lived at the home and five relatives. Most of the people we spoke with were able to tell us about their experiences of what it was like living at Victoria Manor.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at the time of our inspection. Their name appears because they were still the manager on our register at the time.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People confirmed they felt safe at the home. One person told us, "Yes, because I've had no falls since I've been here." They explained this was because assistance was available if they wanted to move around. Another told us, "I feel very safe."

We found staff had completed the required training to support them in delivering care in a safe way.

We checked whether people's medicines were being managed safely. This included checking if arrangements were in place to protect people against the risks associated with the unsafe management of medication. We found that areas of medicine management required further improvement. Arrangements in place for obtaining medicines did not ensure that people’s medicines were always available for them. This meant people’s health could be harmed.

We found complaints, accidents and incidents were not always being recorded. The lack of such records meant accurate monitoring of patterns of complaints, accidents and incidents could not take place to reduce the risks of them reoccurring.

Staff had received training in the Mental Capacity Act and the Deprivation of Liberty Safeguards. This training would support staff in understanding when an application should be made and how to submit one.

Is the service effective?

People’s health and care needs were assessed and people had been involved in planning the care they received. Most people we spoke with were aware of the contents of their care plans. One person told us, “Yes, it’s very good. Seen and understood.” Another person told us, “Yes, and I’m happy with the contents.” One person said, "Yes, and I'm sure I could access a copy. And it is reviewed regularly."

One person had not received their prescribed medication to support their mental health. The person's behaviours were having a negative impact on other people who used the service. There was a lack to information to support staff in managing these behaviours.

Victoria Manor provides a service to people living with dementia. We found there was no sensory or other similar material to provide stimulation and interest or to promote engagement for those people with dementia care needs.

Is the service caring?

During our visit we observed staff speaking to people and their relatives in a friendly manner. People we spoke with told us they were happy with the care and support they received. People felt they were treated as individuals and staff knew their names and a little about their backgrounds. Comments included:

"Very much so, they're very friendly. Even if you need something from the supermarket, they'll get it."

"Yes, they all know my first name."

"They come across and chat to X. There's kindness and connectivity."

Is the service responsive?

People we spoke with felt they could rely on staff responding promptly when they were called. One person told us, "If I get up at night they come quickly. There's an alarm under my mat." Another person said, "Quickly. And my family is advised if I'm not well."

One person responded, "Very quick. They're just around the corner."

Care records we looked at confirmed people were referred to other healthcare service providers when a need was identified. A healthcare professional visiting the home described the staff as “very co-operative”.

Staff completed a ‘resident transfer form’ if a person required emergency medical treatment. The sheet included all the important information the hospital would need to help them understand the medical and psychological needs of the person.

Is the service well-led?

Quality assurance processes were in place to ensure people received a good quality service. There were regular meetings for people and their relatives. An annual quality survey was conducted by an independent research agency on behalf of the provider. The results were analysed to identify any areas where improvement was required.

Staff told us they were supported within their job roles through a system of staff supervision and annual appraisals. One member of staff described support from the management team as "good, they give good support". They went on to say, "There is good support from the staff as well, we work as a team."

The service had an emergency contingency plan in place. This ensured people would have continuity of care if the home became uninhabitable for any period of time.

We visited Victoria Manor on 21 May 2013. The inspection was part of our annual inspection programme as well as a follow up to check on areas of concern identified at our last inspection in January 2013. We spoke to five people living there, three visiting relatives, two care staff, the deputy manager and the manager. We spent time observing the care and support delivered by staff.

We saw warm and kindly interactions between people living there and staff. One person told us, "I love it here." People spoke positively about the staff. One person said, "They couldn't be better. Every one of them is good to me." A relative described staff as 'very kind, very compassionate and very patient'.

Care plans provided staff with sufficient information about how they were to meet people's needs safely and in a way they preferred. We saw that people or their relatives had signed to confirm they had been involved in the formation and agreement of their care plans. Staff we spoke with demonstrated a good understanding of people's individual support requirements.

Staff understood their obligations to report any safeguarding concerns. A visiting relative told us, "It is a relaxed atmosphere. It is homely. There is no tension in the air."

Records we looked at were well organised, accessible and stored securely.

We spoke with 15 of the 24 people using the service at the time of our inspection. We also spoke with the deputy manager, three care staff and the area quality manager who was visiting the care home at the time of our inspection.

People told us that staff maintained their privacy and dignity and they had no concerns about this. One person said, “They’re kind. They don’t ignore us, they talk to us.”

We were concerned that people using the service had limited opportunities to be involved in making decisions about their care and lifestyle.

We observed staff supporting people with their routines of daily living. People were treated respectfully. We saw staff addressing people by their preferred names. We observed that staff were kind, caring and attentive towards people using the service.

We were concerned that staff were not using the tools available to identify risks to the health and welfare of people using the service. This meant timely action might not have been taken to minimise the risks to the health and welfare of people using the service.

We found that the care home was clean and hygienic. Arrangements were in place to minimise the risk of infection.

We saw evidence that satisfactory pre-employment checks were made before staff started working with people who used the service.

We found people could be confident their concerns would be listened to and acted upon.