Victoria Grand

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. The service was being supported by a nurse practitioner from the GP surgery, community matrons and the GP, all of whom conducted regular visits as well as support by telephone. People had care plans in place, they had not always been involved in developing these. Some care plans were not as detailed as they could be to help staff understand people’s care and support needs. We observed staff not always communicating effectively with people. People did not always feel involved with choices and decisions. There were way marking signs and information around the service to help people orientate. Menus and activities were on display, these were available in different formats on request. People attended meetings with the management team to feedback about the service.

This service scored 64 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they had not been involved in developing their care plans. People told us, “All staff are very caring and friendly. Staff do understand what you need and know you well” and “I did ask staff to cut up food for me and they are very helpful.”

The manager told us that people had not been involved in reviewing their care plans previously. This is something they were passionate about changing. The manager told us they were just starting to review people’s care plans with them and their relatives, 2 had been done so far. A staff member told us about person centred care. “Person-centred care is making sure the person is most important and supporting them in a way they are happy with.”

We observed staff supporting people in a person centred way, offering reassurance and kindness. For example, one person was upset because they had misplaced their glasses. A staff member offered reassurance, support to go to another room and then they searched for the missing items and gave them to the person. We observed no activities took place on the day we visited the service. The activities staff were not scheduled to work on that day. People had personalised care plans in place. Some were quite detailed, others required reviewing to ensure staff had all the correct information. For example, 1 person’s emotional support plan didn’t give information to staff to recognise stages of anxiety or to support them in a consistent way. There was nothing to mitigate or consider the impact of the person’s anxieties and behaviours on other people. Another person’s care plan did not fully correspond with information that had been shared at the daily briefing about their mental health needs. This was an outstanding issue from the last inspection.

We observed some good practice with staff responding with kindness and compassion, tailoring their responses to people’s different needs. For example, we observed a person become visibly distressed, staff responded to them and offered them something to eat. The person declined and sat down quite calmly and continued with their crossword puzzle. The staff member had followed the person’s care plan which stated when the person was feeling anxious, tea and biscuits will make them feel better.

Staff told us that there was continuity of support for people living at the service. Most staff had worked at the service for a long period of time. The provider told us they also provided care and support when there had been absences and staff verified that the provider had worked nights on occasions to make sure staffing levels and continuity was retained.

A healthcare professional told us, “I have noticed that since they have a new manager, the home are more responsive and ask for assistance/input much more readily.”

The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. The provider ensured care was joined-up, flexible and supported choice and continuity. For example, when agency staff were used it was staff members that had been used before.

We observed there was way marking in place to help people navigate around the service. Complaints processes were available in each person’s bedroom, behind their door. The menu and activities schedule were on display, these were not in large print or in an accessible format. We discussed this with the provider who told us these could be made available in different formats if people required them. People told us they had not seen a newsletter.

The management team told us that additional signage had been put in place to aid 1 person with finding their bedroom as they had previously become confused and anxious. This signage was particularly helpful because people had moved rooms to enable their old rooms to be renovated.

Since 2016 all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard. The Accessible Information Standard tells organisations what they have to do to help ensure people with a disability or sensory loss, and in some circumstances, their carers, get information in a way they can understand it. It also says that people should get the support they need in relation to communication. The accessible information standards were followed. Care plans detailed people's communication needs. Complaints processes were on display, menu and activity information was on display. The provider told us these were available in accessible formats on request.

There was mixed feedback from people about how well they were listened to and involved. A person told us “I am not offered a choice [of food] if I don’t like it. I am not involved in discussions about the menu.” Another person told us they were “Involved to a degree” with their care planning. We observed staff not always supporting people to make informed choices. For example, asking what people wanted to eat the next day without a picture or written information of the options.

We observed mixed practice from staff in relation to listening and involving people with their care and making decisions. A person’s first choice of lunch was not available and staff discussed between them what alternative the person could be given, the person was not consulted. We observed another situation where meals were placed in front of people without communication about what the food was.

The provider shared with us meeting records to show that they had met with people living at the service. The last meeting had taken place on 29 January 2024. Only 4 people attended and 6 people declined. The meeting records showed they discussed activities, improvements and food. Actions were listed. The provider had amended the records to show when the actions had been completed.

People were supported with medical appointments and follow up appointments. We observed discussions to follow up on medical issues with a GP and the manager. A person told us how the provider had supported them to gain support from the community nursing team. A relative said that their loved one was receiving support from the mental health team and community nursing team. A relative said, “It is fantastic here. He’s had visits to hospital, eye checks, teeth checks, etc.”

Staff gave us examples of when they had recognised people were not acting in their usual manner and the action they took. For example, a person had a chest infection and the GP came straight away. The manager had phoned the GP practice for another person because they had a chest ‘rattle’, the surgery felt it could have been sepsis and so an ambulance was called. Staff told us GP rounds were recorded and discussed at staff meetings.

A healthcare professional told us, ‘Staff appear to be able to discuss the residents and generally understand their needs.’

There were processes in place to ensure that people could receive care, support and treatment when they needed it. The GP carried out a weekly ward round and the service received healthcare input from visiting community nurses and the nurse practitioner from the GP surgery visited weekly. People were also supported to attend healthcare appointments at the hospital when required.

People told us, “Staff know me well. They come in to help me with the commode when I need it” and “They have been very helpful in getting it sorted [bladder problem]. I could take a problem to them if I had one. They don’t get cross if the bed is wet. All really nice staff and I really like it here.” A person felt they were unable to openly discuss their religion with staff because they were fearful of prejudice based on possible perceptions of the religion and how it is practiced. They told us that the impact of this was minimal as they were able to be open with friends.

Some staff did not know people’s care routines and risks well and told us they would look up the person’s information and risks at the point of care being provided. We observed that some staff did not use effective communication when supporting people.

The processes to gain people’s views and experiences were in place. Meeting records showed that only a small number of people had attended the last residents meeting. Some people we spoke with were unable to recall attending a meeting or being asked to feedback. The provider may wish to consider how they will gain feedback from people who do not attend the meetings to make these more inclusive and to ensure people whose voices are seldom heard are included.

People were supported to plan for important life changes. The manager was trying to have conversations with people about advanced care wishes and was in the process of arranging for people’s wishes to be recorded. The manager had started to review care with people and their families. The manager talked about arranging this for a person with their daughter. The manager explained another person had capacity and was involved in decisions about their care already. The manager told us about another person who liked to drink a particular alcoholic drink. The manager explained they sought advice from the pharmacy to ensure that alcohol would not interfere with the medicines. The person was very pleased when a bottle of their favourite alcohol was bought by a relative and they enjoyed a drink of it.

Information for staff about people’s wishes were recorded in their care plans. The manager told us about a person who was due to have a medical procedure completed in hospital as they had been unwell and been passing blood in their faeces. The hospital wanted to undertake a colonoscopy and this had been explained to the person and they had consented to this procedure. However, when the hospital appointment day arrived, the person went to hospital, but then refused to have a colonoscopy, so came back to the service. The person’s views were respected and their relative was also involved. The manager had identified this person would benefit from having a meeting to accurately log their wishes around future medical interventions.

The provider had systems and processes in place to understand the diverse health and care needs of people living at the service. Some people had a DNACPR (Do not attempt cardiopulmonary resuscitation) form in place. This is an advanced decision not to attempt CPR. It is not about other treatments or care. The manager was in the process of supporting people and their relatives to complete ReSPECT (Recommended Summary Plan for Emergency Care & Treatment) forms. A ReSPECT form records a person's wishes about a range of care and treatments. People were appropriately referred to dementia specialists, speech and language therapists and occupational therapists when this was required.