Archived: Victoriana Care Home

Updated 16 February 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

This inspection was completed by two inspectors.

Service and service type

Victoriana Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Victoriana Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was no registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 10 people who used the service and six relatives about their experience of the care provided. We spoke with 15 members of staff including care workers, senior care workers, domiciliary care workers, the cook and members of the management team including the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included three people’s care records and numerous medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 16 February 2023

About the service

Victoriana Care Home is a residential care home providing personal and nursing care to up to 34 people. The service provides support to people who may be living with a physical disability, mental health needs or dementia. At the time of our inspection there were 29 people using the service.

Victoriana Care home is split across three floors. People have access to their own personalised bedrooms and share communal areas such as lounges, bathrooms, dining areas and a garden.

People’s experience of using this service and what we found

There was ineffective leadership at the service and governance systems were not identifying areas where improvements were needed. Audits were either not in place or not effective at identifying where actions needed to be taken. A lack of manager presence at the service had allowed a negative culture to develop which did not promote positive outcomes for people. The provider was not reporting statuary notifications to the CQC in line with requirements. People, relatives and the staff team were not being asked to feed back about the service.

Risks to people were not thoroughly assessed and risk assessments lacked detailed guidance for staff to follow. These included risks relating to fire. There were numerous infection control issues at the service and the home needed some upkeep and a deep clean. Systems were not in place to review accidents and incidents to help ensure people were safeguarded from abuse. There were enough staff to support people safely, however staff were not supported to get to know people well as individuals. People were supported safely with their medicines for the most part.

People did not receive personalised care and there was not a focus on their individual likes, dislikes and preferences. Staff were not trained or knowledgeable about people’s specific health conditions. People were not being supported to engage in social pastimes which they were interested in. Staff interactions with people were task based and there was little effort made to engage with people in a meaningful way. We have made a recommendation to the service around considering best practice when communicating with people.

People were not always treated with kindness and compassion and their privacy and dignity was not always respected. Staff did not always support people to remain independent if this was their choice. People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

Staff did not always have the right training or knowledge to support people effectively. People were supported to see health professionals, however advice from health professionals was not always recorded in detail in people’s support plans. Changes needed to be made to the environment to help support people living with dementia to orientate. People’s needs were not always reassessed in a timely manner.

Some people gave positive feedback about their care. One person said, ‘‘I really like it here. The staff are genuine and look out for me.’’ People were positive about the food and drink at the service. Some staff spoke with people in a kind way. The management team gave us some assurances they would begin addressing the issues we found at this inspection.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 November 2020). The services rating has now changed to inadequate. This service has been rated requires improvement or inadequate for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, person centred care, the reporting of notifiable incidents and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.