Victoria Care Home

We found the following examples of good practice.

Visitors were not able to access the home without providing evidence of a negative LFT result. Professionals were also required to provide evidence of vaccination against COVID-19. There was sufficient space indoors and outdoors for safe visitation to take place. Visitors were limited to agreed areas of the home to reduce the risk of the spread of infection.

Staff were observed wearing PPE where required. When staff provided personal care, new PPE was used before care was provided. Staff were provided with PPE stations outside people’s bedrooms when isolating and also at regular intervals throughout the home.

There were numerous communal areas which had been arranged in a way that encouraged social distancing. We observed people being encouraged to social distance by staff. The layout of the home, with three separate units, meant the provider was able to reduce mixing between large numbers of people and staff.

The home was currently in ‘Outbreak status’ meaning the home was closed to non-essential visitors until the home was clear of COVID-19. However, we were informed that pending results of testing the home was due to re-open soon. Safe isolation procedures were in place to protect others from the risk of infection. There were ample supplies of PPE throughout the home.

The provider had processes in place that ensured the safe admission of new people to the home. People were required to isolate until a negative PCR result (following a negative LFT result) was received. Increased staff presence and activities within their bedrooms was provided to reduce the impact of isolation on people’s wellbeing. All new admissions had to meet required vaccination status and negative LFT result before entry was granted to the home.

It was acknowledged isolation for people living with dementia was difficult at times. Increased support from staff was in place where needed. Posters were placed around the home offering guidance and information for people and staff advising them how to spot the signs of COVID-19 and to help to reduce the risk of spreading it.

Regular testing of staff and people was in place. All staff and people living at the home were tested regularly and in accordance with government guidance. The provider had ensured they complied with Government guidelines on testing and vaccination for staff.

Regular cleaning of all touch points and other key areas were carried out throughout the day. We observed the home was visibly clean and tidy.

There were enough staff to support people safely and to cover any staff holidays, sickness and COVID-19 isolation. Agency nursing staff had been used to cover a small number of night shifts. The same staff were used each time to aid consistency of care but also to offer reassurance that those staff were following the required guidelines on vaccination and testing.

The provider considered staff member’s wellbeing. A variety of initiatives were in place to thank staff for their support.

The provider had assessed the impact of potential ‘winter pressures’ and acted accordingly. Regular COVID-19, outbreak and other related audits were carried out to help identify any areas of concern. Action plans were in place and reviewed.

Victoria Care Home is a residential care home that provides personal and nursing care for

up to 93 people. At the time of our inspection 70 people lived in the service.

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

Sufficient numbers of staff to cover and support people’s needs were deployed across all areas. The provider used a dependency tool to identify the number of staff required for each area. Appropriate safety checks were in place to ensure staff were safe to work with people.

Risks were assessed and managed. Since our last inspection the provider had implemented new ways of working to ensure people at risk of choking were kept safe.

People received their prescribed medicines safely. The system for managing medicines ensured people were given the right dose at the right time. PRN protocols were in place but required more details to why the medicine was being given.

We recommend the provider reviews PRN protocols.

Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences.

Staff wore personal protective equipment (PPE) effectively. The service was kept clean to minimise risk of people acquiring an infection. We were assured that the provider was preventing visitors from catching and spreading infections and were assured that people were admitted safely to the service.

The service was well-led, and staff were empowered to do their job, but the registered manager required further oversight when delegating the workload.

The service engaged and involved people and their relatives to ensure they were kept up to date on what was happening at the service. One person said, “They are keeping me informed at the moment, with me being ill, as I used to go three to four times a week, they had no objections me looking in his care plan, if I have a problem I do speak to staff. I have been kept informed, this COVID stopping people going in.

Personal information was stored correctly, but some files contained sensitive information

We have made a recommendation that the provider reviews personal information kept on care files.

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 24 December 2019). and there were breaches of regulations 12, and 18 of the Health and Social Care Act Regulations 2014.The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection some improvements had been made and the provider was no longer in breach of regulations. Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and staff deployment.

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.

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

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 providers to account where it is necessary for us to do so.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People that we spoke to said that Victoria Care Home was a good place to live and that staff treated them with respect and kindness. However, we found that monitoring risk was not always appropriate and advised the registered manager to relocate a listening device to ensure that only staff were able to hear it.

There was not always enough staffing to meet people’s needs. The nursing unit had staff deployed which met with the staffing required. However, not all staff deployed were carrying out moving and handling which meant that there was not enough staff to enable people to be cared for appropriately.

People’s health and social care needs were managed well by management and the staff team. There were positive relationships with professionals which supported people’s overall wellbeing.

Medicine was administered safely and there were clear protocols in place for medicine taken’ when required’. Records were kept up to date and Medication administration records (MAR) were all correct and checked by staff and the registered manager.

The registered manager showed evidence of ongoing quality monitoring across all aspects of the service. Any concerns raised by residents’ relatives or staff were investigated and addressed. This was also used to inform improved practises throughout the home.

People had enough to eat and drink. People were offered choices and had an input into the menu planning. The lunchtime experience was relaxed, and staff were assisting with serving meals and assisting people where necessary. However, staff weren't deployed effectively so that all those who required assistance, received it.

There were a variety of activities both to keep people occupied and entertain them and physical activities to assist with people’s mobility. However, not all people were engaged or consulted about activities and the registered manager agreed that this needed to be planned better.

Enforcement

We found breaches in relation to safe care and treatment in not mitigating risk in relation to choking and in relation to staffing not being sufficient to meet the needs of people living at the service.

Rating at last inspection: At the last inspection Victoria Care Home was rated as Requires Improvement. The last inspection took place on 6 June 2018. At this inspection the home has remained the same.

Why we inspected: This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection. The registered manager now has systems and processes in place to respond to complaints and to monitor the quality of the service.

Follow up: We will monitor all intelligence received about the service to inform the assessment of the risk profile of the service and to ensure the next planned inspection is scheduled accordingly.

The service had a registered manager at the time of our visit. 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 2008 and associated Regulations about how the service is run.

At our last inspection in December 2017 we identified improvements were required to ensure the quality and safety of people’s care at the service. For example, people were not always kept safe from abuse or avoidable harm; people rights were not protected under the Mental Capacity Act 2005 and complaints were not always captured or responded to appropriately. We found multiple breaches of Regulations. The service was rated as Inadequate.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. Following the last inspection, we met with the provider to confirm what they would do and by when to improve the quality and safety of the service. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. Following this inspection the service was rated as Requires Improvement.

Risks to people’s health and safety had been assessed. However, further improvements were required to ensure that equipment people needed was provided in a timely manner and sufficient guidance about how to keep people safe was provided to staff. People were supported by sufficient amounts of staff who had been recruited safely. Staff understood their responsibility to protect people from the risk of abuse and what action to take if they suspected abuse. People received their medicines safely and lived in a clean home.

People were supported by staff who received training and support. An assessment of people’s needs was carried out before they moved to the home. People were supported to eat and drink and the advice of external health professionals was sought when needed. People lived in a building which met their needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.

People were supported by staff who were kind and compassionate. Staff knew people well and took time to understand their needs and wishes. People were involved in planning and reviewing their care and had access to independent advocacy. People could be assured that their privacy and dignity were respected by staff.

People received care and support in line with their preferences. Care plans contained guidance for staff about people’s needs and how these should be responded to. A range of activities were provided for people at times to suit them. People were provided with opportunities to make a complaint about their care and complaints were responded to appropriately. Staff were provided with information about how people wished to be cared for at the end of their lives.

Improvements had been made to the systems in place to monitor the quality and safety of the service. However, further improvements were required. The provider also now needs to show they can continue and sustain improvement. The provider had complied with conditions of their registration and we had been notified of certain events which had taken place in the home. People and staff told us the atmosphere of the home had improved and they had opportunities to provide feedback or make suggestions for improvement.

There was no registered manager in post at the time of our inspection; the previous registered manager had left the service in September 2017. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. An interim manager had been in post since September 2017 and they were in the process of applying to register with the CQC.

At the last comprehensive inspection of this service on 20 December 2016, we asked the provider to take action to make improvements to the governance of the service. Sufficient improvments were not made and during this inspection we found multiple breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People were at risk of unnecessary harm. Systems in place to protect people from the risk of abuse or improper treatment were not effective. People were not always protected from risks associated with the premises or the improper use of equipment. People were not always protected from risks associated with their care and support. People were not always supported by sufficient amounts of staff and staff were not always recruited safely. People could not be assured that the management of medicines was safe and that equipment used was clean.

People’s rights under the MCA were not always protected as the Act had not always been applied to ensure that decisions were made in people’s best interests. People could not be assured that staff had the skills and training they needed to meet people’s needs in an appropriate way. People did not always get the support they required to eat their meal in a safe way and records did not show that people were always supported to drink a sufficient amount. People had access to health professionals, however, information in care plans about the support people required to maintain good health was not always clear. Although the premises had been adapted to the needs of people living there, improvements were required to ensure that equipment and safety measures were used appropriately.

People told us that most of the staff at Victoria Care Home were caring although some staff did not always display a caring attitude. Our observations supported what people had told us. People’s privacy and dignity was not always respected. People had access to advocacy services.

People were at risk of receiving inconsistent support which was not always personalised to their needs. People’s care plans contained limited information about how staff should support them in line with their preferences at the end of their life. People were supported to take part in some activities and social opportunities although at other times people were provided with little stimulation. Improvements were required to ensure that people’s concerns and complaints were captured and responded to appropriately.

The service was not well led. Systems in place to monitor and improve the quality and safety of the service were not effective and this placed people at risk of harm. Some areas of service provision were not robustly monitored and effective action was not always taken in response to issues identified. People were provided with opportunities to provide feedback on the service they received but these were limited and did not capture the concerns identified during this inspection. Staff felt motivated by the manager of the service and felt that improvements were being made.

The overall rating for this service is ‘Inadequate’ and the service is therefore in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question of overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 Care Home is located in Worksop, Nottinghamshire, and provides nursing and residential care for 93 people. At the time of our inspection, 79 people were using the service which is divided into four separate units. The Camelot unit provided residential care, the Lancelot unit also provided residential care and support for people with dementia. Nursing care was provided in the Guinevere unit and Champion Crescent provided support for people with an alcohol related brain injury.

The service 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 2008 and associated Regulations about how the service is run.

We carried out on unannounced comprehensive inspection of this service on 20 December 2016. Breaches of legal requirements were found and we issued a warning notice in relation to one of these breaches. We asked the provider to take action to ensure that the service was responsive to the needs of the people who lived there.

We undertook this focused inspection to confirm that the provider had met the requirements of the warning notice. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Victoria Care Home on our website at www.cqc.org.uk.

Action had been taken update care plans and to reinforce the need for clear recording with staff.

People’s care plans contained detailed information which provided clear guidance to staff although further improvements were required to ensure these were reviewed when people’s needs changed. We found that staff were aware of people’s needs and any recent changes.

Victoria Care Home is located in Worksop, Nottinghamshire, and provides nursing and residential care for 93 people. At the time of the inspection, 83 people were using the service, which was divided into four separate units. The Camelot unit provided residential care. Lancelot unit also provided residential care to support people living with dementia aged over 65 years. Nursing care was provided in the Guinevere unit which also catered for people with higher dependency needs and short term care placements. Champion Crescent catered for people with an alcohol related brain injury in supported living flats.

The service 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 2008 and associated Regulations about how the service is run.

People’s medicines were stored and handled safely. Although there were enough staff to ensure people were safe, we observed people's immediate care needs were not always anticipated and responded to. Risks were assessed, but these risk assessments were not always updated. Any accidents and incidents were investigated so that steps could be put in place to avoid reoccurrence, but the mitigating measures were not always implemented or used. The staff understood their role in keeping people safe. People who used the service and those supporting them knew who to report any concerns to if they felt they or others had been the victim of abuse.

Staff had received the training and supervision they needed to support people effectively, although some people did not have confidence in the ability of the staff that supported them.

The registered manager applied the principles of the Mental Capacity Act 2005 (MCA) and Deprivations of Liberty Safeguards (DoLS), so that people’s rights were protected.

People told us the food was good and they were able to choose what they ate.

People’s healthcare needs had been assessed and were regularly monitored. The service worked well with visiting healthcare professionals to ensure they provided effective care and support.

People were supported by staff in a respectful, kind and caring way, but interactions with staff tended to be task related and there was little social interaction. Staff did not always act to promote peoples dignity, although they respected their privacy and encouraged people to be independent. People had access to independent advocacy services. There were no restrictions on friends and relatives visiting.

The service did not always respond to people’s changing needs. Care plans were not consistently updated to take account of peoples changing needs. There were not always full records of the support people had received to be sure that they had received the care that they needed.

People were able to participate in group activities or to spend time on their own pursuing their hobbies and interests if they preferred. Trips out of the home were organised.

A complaints procedure was in place and people felt comfortable in making a complaint if needed.

Auditing and quality monitoring processes were in place, but these were not sufficient to identify the issues we have found during our inspection. There was a positive atmosphere within the home and people’s views were considered when making decisions to improve the service. People spoke highly of the registered manager.

Due to the complex needs of some of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider and we considered information from our last visit on the 12 October 2013. During the visit we spoke with six people who lived at the service, four care workers and a qualified nurse. We also spoke with the acting manager, the deputy manager, the operations director and the head of clinical governance.

We looked at some records including staff training, rota's and cleaning schedules. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We observed the home was clean and free from any unpleasant odours. We saw that the decorating schedule had continued since our last visit in October 2013 and the corridors were bright and cheerful with people's doors painted in bright colours to help them orientate themselves.

Staff morale appeared to have improved since our last visit and we observed staff working with people in a cheerful and respectful manner. Staff were welcoming to us and remained helpful throughout the visit.

People who used the service told us, 'I have lived here for three years and have always been happy and contented.' Also, 'The staff go out of their way to please me and long may it continue.'

We saw that there were sufficient numbers of suitably trained and experienced staff to meet people's needs.

We visited Victoria Care Home with a representative from the Bassetlaw Clinical Commissioning Group and a Marketing and Development officer from Nottinghamshire County Council.

We undertook a partial tour of the building, focussing on clinical areas and bathrooms.

We spoke with six members of staff, two residents and one person who was visiting a relative who lived at the home. We also spoke with the person who took responsibility for the service on behalf of the provider organisation. (Nominated Individual or NI).

Our colleagues from health and the local authority also undertook a partial tour of the home and spoke with a variety of staff members, people living at the service and visitors to the service. They provided a separate report for the provider.

We found the premises were suitable for their use and people were in safe, accessible surroundings that were being continually maintained. Staff we spoke with told us a lot of refurbishment and re-decoration had taken place and would be continuing.

A relative told us 'I've never had problems with cleanliness when I've visited. My relative is always well cared for and wears clean clothes. Their room is clean and tidy.'

However, we found that in some areas of the home there were unpleasant odours. This had been identified in the infection control inspection carried out in July 2013 and we felt the provider had not taken the necessary action to resolve this.

During the visit we spoke with five people who used the service and one relative and asked them for their views. We also spoke with four care workers, a domestic assistant, the registered manager, the Head of Clinical Governance and the Director of operations. We looked at some of the records held in the service including care files for five people. We observed the support provided by staff to the people who used the service.

We found people received care and support that met their needs. A person told us,' I am cared for really well and cannot imagine where I would be without them'

We found people were safeguarded from abuse. A relative told us, 'I have never seen anything untoward or any poor practice.'

We found the provider had taken steps to ensure there was sufficient and suitable staff available. On the day we visited a member of staff had called in sick and the shift was covered by another staff member who told us that they enjoyed working on the unit and would always agree to cover shifts when possible.

We found the provider had a system to deal with comments and complaints. A person told us, 'I would always tell someone if there was anything wrong."

Staff told us they would report anything of concern and trusted the unit manager and the home manager to deal with their concerns.

During the visit we spoke with four people who used the service and one relative and asked them for their views. We also spoke with two care workers, a registered nurse, the deputy manager and the registered manager.

The manager told us that the home had introduced an opportunity for people to meet informally with the manager over a cup of tea. This was referred to as 'Tea with the manager.' This took place each week and people were invited to sit with the manager in small groups to enable them to discuss things on an informal basis.

We also looked at some of the records held in the service including the care files for three people. We observed the support people who used the service received from staff.

We undertook a partial tour of the building to observe care practice and general cleanliness.

A relative told us, " I can't praise the home highly enough. Of course I was very apprehensive when my relative first came into care but they settled in well and like living here.' And 'They are very independent and always say what they want and how they want to be looked after. The staff respect their wishes.'

We found people gave consent to their care and treatment and received care and support that met their needs. A person told us, 'They (staff) know they are doing well. They always ask if I am alright. I like it here.'

We found people were safeguarded from abuse. A relative told us, 'I have never seen anything untoward or any poor practice.'

We found the provider had taken steps to ensure there were sufficient and suitable staff available. One person told us their only concern was, 'There were not enough staff.'

We found the provider had a system to deal with comments and complaints. A person told us, 'I would complain if I wasn't happy, but I am happy.'