Archived: Victoria House

Updated 12 October 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Victoria House 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. Victoria House is a care home without 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 not a 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, including information from the registered provider about important events that had taken place at the service, which they are required to send us. We sought feedback from the local authority.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with five people using the service and four relatives about their experiences of the care provided. We spoke with 10 members of staff including the manager, the regional manager, head of care, maintenance person and care staff. We also spoke to the nominated individual for the service. A nominated individual is responsible for supervising the management of the service on behalf of the registered provider.

We reviewed a range of records. This included 14 people’s care records, various medication records, accident and incident records, two staff recruitment records, staff files and we looked at a variety of records relating to the management of the service.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 12 October 2022

About the service

Victoria House Residential Home is a residential care home providing personal care up for up to 30 older people some of whom may have dementia. There were 21 people living at the service at the time of the inspection.

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

People using the service and their relatives had mixed feedback in relation to people’s safety and care approaches at the home. Some relatives felt people using the service were not safe. Our observations and findings showed people did not always receive safe care and treatment. Risks to people’s health and wellbeing were not always sufficiently monitored and managed. Records of care did not accurately indicate the support provided to people. Guidance to staff on what actions they were to take to manage risks was not always available or individualised to ensure each person received care suitable to their needs. Risk management in relation to nutrition and hydration and pressure care needed to be improved.

People were not supported by adequate numbers of suitably qualified staff to reduce the risk of harm. Not enough staff were deployed to meet people’s needs. There was a lack of clarity on how caring responsibilities were assigned to staff to ensure people received care when required.

The governance systems at the service were not adequately implemented to protect people from risks, to promote a person-centred approach and deliver safe and high-quality care. Audits did not always identify the shortfalls we found. In addition, audits were not always used to address shortcomings in a timely manner and some had continued since our last inspection.

Staff provided mixed responses in relation to the culture and management style; particularly from head office. Staff morale was low and agency cover was not always valued. There was a lack of robust oversight to ensure risks to people were continually monitored to prevent deterioration. There was an ongoing high turnover of managers which could affect development of community links with local health and social care services and the running of the home.

People’s care records did not always reflect the nature of care provided. Staff did not always maintain accurate records which may hinder the support and delivery of safe and person- centred care.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 7 April 2022).

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.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria House on our website at www.cqc.org.uk.

Enforcement

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 continued breaches in regulation in relation to safe care, staffing and good governance at this inspection. The registered provider took immediate action to address some of the concerns and improve people’s experiences.

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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’. The service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, we will take action 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.