Archived: Victoria House

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.

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 23 people living at the service at the time of the inspection.

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

People and their relatives told us they felt safe with the care provided. However, our observations and evidence collected showed that people did not always receive safe care and treatment.

People were exposed to risk of the spread of infections because infection prevention and control systems were not robust. People received care from an insufficient number of suitably qualified staff to reduce risks of harm.

People received care in premises that were not maintained appropriately. Safeguarding concerns had not always been shared with relevant authorities or the Care Quality Commission (CQC).

People’s care delivery was undertaken by staff who were not always supported in their roles. The majority of people’s care records we saw reflected their needs and the support they received. Records keeping of two people we viewed did not accurately reflect the care provided to them. People’s privacy and dignity were not always respected.

The provider had not established robust oversight to support staff, monitor people’s experiences and monitor compliance with regulations. The governance systems were not effectively implemented to protect people from risk of avoidable harm and to promote an inclusive, person-centred approach and the provision of safe and high-quality care. Records about the service and care delivery were not always updated.

Audits identified some of the issues we found during this inspection, but these were not always addressed and/ or followed up in a timely manner. There was a lack of robust management oversight to ensure the risks we identified were continually monitored to prevent deterioration.

We did not observe any staff interacting with people who chose to stay in their rooms or who were receiving support at the end of their lives. This may have subjected people to poor experiences due to insufficient monitoring of their care and support.

Staff’s feedback was negative in relation to the culture and leadership style in the home. There was lack of cohesion in the team. There had been a high turnover of care staff and managers which had led to low staff morale and shortages.

People were supported with their nutrition and hydration needs. People had access to the health and social care services they required.

People and relatives told us staff were kind and caring. We observed staff interactions with people and found them to be warm, respectful and kind.

Risks associated to staffing levels, record keeping, governance, notifications, premises and infection prevention and control needed to be improved.

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

The last rating for this service was good (published 16 March 2019). The service has deteriorated to inadequate.

Why we inspected

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

We have found evidence that the registered provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this report. The registered provider took immediate action to address some of the concerns we identified to improve people’s experiences.

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 coronavirus and other infection outbreaks effectively.

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 discharge our regulatory enforcement functions required to keep people safe and to hold register providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from preventable harm, premises that were not maintained and weak infection prevention and control practices. We also found concerns in relation to privacy and dignity, deploying of sufficient suitably qualified staff, failure to report incidents and poor governance at this inspection.

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 work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 registered provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the registered 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 take action in line with our enforcement procedures. This will mean we will begin the process of preventing the registered provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of 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.

Victoria House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home provides accommodation for up to 30 older people some of whom may have dementia. It is located in the Kew area of Richmond in Surrey.

The home had a registered manager. 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 and associated Regulations about how the service is run.

At the last inspection in November 2017, the key question of well-led was rated requires improvement. The other key questions of safe, effective, caring and responsive were rated good. The overall rating was good. We identified one breach of the regulations regarding the quality assurance system which had not picked up that reviews on the samples of care plans we looked at had not been updated. At this inspection the requirements of this regulation were met.

People said the home had a friendly and relaxed atmosphere with well provided care and support. There were plenty of staff to meet people’s needs and they did so in a respectful, kind and compassionate manner.

The home kept thorough, comprehensive and up to date records that were regularly reviewed with information presented in a clear and easy to understand way.

People were encouraged and enabled to discuss health needs and had access to community based health professionals as required as well as the home’s care staff. People’s diets were balanced, protected them from nutrition and hydration associated risks and also met their likes, dislikes and preferences. Some people said the meals available were of good quality, plentiful and there were sufficient choices provided. Others felt they could be improved. Staff prompted and supported people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy meals.

The home was clean, well-furnished and maintained and provided a safe environment for people to live and staff to work in.

Staff were very knowledgeable about the people they supported and had appropriate skills and training to meet people’s needs competently. They provided people with individualised care in a professional, friendly and supportive way.

Staff were aware of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

The Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) require the provider to submit applications to a ‘Supervisory body’ for authority. Applications had been submitted by the provider, applications under DoLS had been authorised and the provider was complying with the conditions applied to the authorisation.

Staff said the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives said the registered manager and staff were approachable, responsive and they encouraged feedback.

The home had systems that consistently monitored and assessed the quality of the service provided.

The health care professionals that we contacted were very positive about the care and support provided by the home and raised no concerns regarding its quality.

Victoria House 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. Victoria House accommodates 30 older people in one adapted building.

The home had a registered manager. 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 and associated Regulations about how the service is run.

At the last inspection in December 2015 all the key questions of safe, effective, caring, responsive and well-led were rated good and there was an overall rating of good. At this inspection we have made a judgement of requires improvement for the well led question. This failing represents a breach of the Health and Social Care (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People and their relatives said the care and support provided at Victoria House was very good and they liked its friendly atmosphere. There were enough staff available to meet people’s needs and the staff were friendly, helpful and attentive providing care and support in a kind and skilful manner.

Most of the home’s records were comprehensive, kept up to date and regularly reviewed with information recorded in a clear and easy to understand way. However the quality assurance system had not picked up some review information that had not been updated on a sample of people’s records. We have made a requirement in respect of this.

People and their relatives were encouraged to discuss health needs with staff and had access to community based health professionals when required. They were protected from nutrition and hydration associated risks by balanced diets that also met their likes, dislikes and preferences. People and their relatives said the quality of the meals provided and available choices was good. People were prompted to eat their meals and drink at their own pace.

Victoria House was well maintained, furnished, clean and provided a safe environment for people to live and staff to work in.

Staff were competent and knowledgeable about the people they cared for. They had appropriate skills and training and were focussed on providing people with individualised care and support. This was provided in a professional, friendly and supportive manner. They were aware of their responsibilities to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences. Staff said the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives thought the registered manager and staff were approachable, responsive, encouraged feedback from people and consistently monitored and assessed the quality of the service provided.

We were told that people using the service and their families participated fully in choosing to move to the home. This was confirmed by the assessment and care plan information we looked at. Someone said "This is for the rest of my life and I wouldn't tolerate anything less than the standard of service I receive here".

People using the service were very involved in the care and support that was delivered and the way that it was provided. One person told us "The people running it know what they are about, don't intrude, are well trained and the particularly good thing is there is something on every day".

They said the type and quality of care they received from caring and competent staff was excellent and they enjoyed living at the home. People commented "I wouldn't have done all the things I have if I was at home" and "I'm so much happier here than living at home".

They also told us that there were enough staff to support them and "Nothing was too much trouble".

They also said that they were aware of the home's complaints procedure but had not had cause to use it.

We found that people living at the home were treated with dignity and respect during the inspection and they and their visitors were treated with courtesy and greeted in a friendly and welcoming way.

The records we saw were up to date, regularly reviewed and people using the service were encouraged to contribute to the way care and support was given to them.

There was a thorough assessment process prior to people moving in and they were encouraged to visit as much as they liked before deciding if they wanted to move in.

There was extensive building work being carried out during the inspection. This was done in an unobtrusive way with as little disruption to people living at the home as possible.

There were suitable staffing levels to provide people with the support and service they needed and wanted.

There was an easily accessible complaints policy and procedure and clear complaint investigation process.

They did not tell us about the support staff received from the home or the quality assurance system in place. They did tell us that "There was huge co-operation with the catering manager over the menus we preferred". They also said that the home meetings took place and this was reflected in the meeting minutes we looked at.

There was also a quarterly news letter.