21 September 2022
During a routine inspection
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.