All inspections: Victoria Lodge Care Home

The last inspection of this home was carried out in October 2015. At that time the provider was failing to meet a legal requirement about medicines recording and induction of agency staff. The provider sent us an action plan showing how they would address these matters. During this inspection we found the provider had made improvements in these areas. Medicines records were completed and agency staff were provided with induction so they were aware of safe working practices within the home.

This inspection was carried out on 26 October and 1 November 2016. The first day of the inspection was unannounced.

Victoria Lodge Care Home is registered to provide accommodation and nursing or personal care for up to 46 people. It is a purpose-built care home with two units. The ground floor unit provides care for younger adults who are physically disabled and the first floor provides care for frail older people, some of whom may be living with dementia. At the time of this visit there were 11 people living on the ground floor unit and 25 people accommodated on the first floor.

The home had a registered manager who had been in post for a year. 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.

During this inspection we found some gaps in some people’s care records that could lead to inconsistent care. We also found that bathrooms were not in a good state of repair and were cluttered. The provider had a quality assurance system but this had not always identified or addressed the shortfalls found during this inspection.

You can see what action we told the provider to take at the back of the full version of the report.

People said they felt safe and comfortable at the home. Relatives told us it was a safe place for their family members. One relative told us, “I’m sure it is safe. I checked several homes before this one and I know my [family member] is safe here.” Staff had regular training in safeguarding adults and understood their responsibilities to protect the people who lived there.

There were enough staff on duty to support the people who lived there. The staffing levels and skill mix throughout the day and night was suitable to meet people’s needs. The provider carried out checks to make sure only suitable staff were employed.

People and relatives we spoke with felt staff had the right skills to care for people. Staff told us they had good training opportunities.

People’s right to make their own decisions was respected and their consent was sought before care was provided. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

People were supported to eat and drink enough to meet their nutrition and hydration needs. Any changes in people’s health were referred to the relevant health care agencies.

The people we spoke with who were able to express a view told us they liked the staff and had good relationships with them. One person commented, “The staff are really nice. They are very cheerful and chatty.”

People and staff enjoyed friendly, appropriate interactions. Although staff were busy they stopped to have chats with people and with visitors as they passed by.

Relatives felt staff were caring and patient. One relative told us, “Staff work very hard and are always busy, but they are always cheerful and friendly. I’ve never heard a wrong word from any of them when they’re helping people.”

The home employed an activity staff member who was enthusiastic and motivated. People told us they enjoyed various activities arranged by the activities staff member. One person told us, “There’s plenty to do. [Name of activity staff] always has something going on for us.” There were opportunities for people to go out shopping and to weekly pub lunches.

There was information in the home for people and visitors about how to make a complaint. People said they would feel able to raise concerns if necessary.

People told us they were kept informed about changes in the home and were encouraged to give their suggestions and comments. People and visitors were asked to complete individual questionnaires and also to join regular meetings which gave people a chance to give suggestions as a group. One relative commented, “We have residents/relatives meetings with the manager. She asks what we think and listens to what we say.”

The staff we spoke with felt the registered manager was approachable and supportive. One care worker told us, “I think the home is well-managed.” Another staff member commented, “We have staff meetings and can say if we think something could be improved.”

Victoria Lodge Care Home is registered to provide accommodation and nursing or personal care for up to 46 people. It is a purpose-built care home with two units. The ground floor unit provides care for younger adults who are physically disabled and the first floor provides care for frail older people, some of whom may be living with dementia. At the time of this visit there were 14 people living on the ground floor unit and 23 people accommodated on the first floor, two of whom were staying for a short-break.

This inspection took place over two days. The first visit on 13 October 2015 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 14 October 2015.

There had been three changes of manager since the last inspection. The new post-holder had begun the process of applying for registration as a 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.

At the last inspection of this care home, which was carried out on 11 and 12 February 2015, we found the provider had breached two regulations. These related to: care records which did not always reflect people’s needs; and lack of staff supervision. After the inspection on 11 and 12 February 2015 the provider wrote to us to say what they would do to meet legal requirements.

During this inspection visit we found that new care records had been put into place, which were an improvement, and staff had received some supervision and this was on-going. This meant the provider was addressing these areas and was no longer in breach of those regulations.

However we found other breaches of regulations during this visit. These related to the safe induction of agency staff and to the records about medicines.

There were only four permanent nurses working at the home to cover day and night time, so there had been several shifts where agency nurses were in charge. People said they felt they were being looked after by “strangers”. Agency staff received a handover about people’s care needs. However the home had not made a record of whether agency staff had an induction of the home, including fire safety and contingency plans, before they started their shift. This meant when the agency nurses were in charge they may not know what to do in the event of an emergency, which presented a potential risk for people living there.

Medicines records were not always completed, so it was difficult to tell if someone had received their medicines or not. Some people needed ‘as and when required’ medicines but the guidelines about this for staff were not detailed enough to show when those medicines might be necessary. For example some ‘as and when required’ guidelines simply stated that the medicine was for ‘pain’, but some people were not able to express when they were in pain.

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 were positive about the service. People said they felt safe and comfortable with the permanent staff at the home. Staff were clear about how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected.

Since the last inspection staff had had some opportunities for more training and supervision but this was still in progress and the new manager recognised that further improvements were needed to how this was recorded.

Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. People’s safety was protected without compromising their rights to lead an independent lifestyle.

People who used the service and their relatives told us they felt well cared for in the home. People were supported to eat and drink enough to meet their nutrition and hydration needs. Any changes in people’s health were referred to the relevant health care agencies.

People and visitors were positive about the care and kindness they received from staff. One person told us, “I am so very satisfied. This is better than being at home. The staff are very good to me.” Another person commented, “The staff get me what I want. The place is clean and tidy. The staff are very good.”

There was a good rapport between people and the staff on duty. Staff chatted to people as they passed and people were assisted in a cheerful way. A visitor told us, “This place is spot on. My [family member] is well cared for and we are happy. The staff even take him for a drink to the pub on Fridays.”

People and relatives told us there was a good range of activities at the home. Staff made sure people had the chance to go out shopping or to local places of interest, including the church and pub. People had information about how to make a complaint or comment and these were acted upon.

There had been three changes to the management of this home this year. People told us they felt sorry for the staff because of all the changes in management. Staff said that it had been a “struggle” with the changes in management to create stability.

The provider had a quality assurance programme to check the quality of the service. This included improvements to the way people’s views were sought and acted on.

Victoria Lodge Care Home provides accommodation and nursing or personal care for up to 46 people. It is a purpose-built care home with two units. The ground floor unit provides care for younger adults who are physically disabled and the first floor provides care for frail older people, some of whom may be living with dementia. At the time of this visit the ground floor unit was full with 16 people and there were 21 people living on the first floor unit.

The last inspection of this home was carried out on 20 August 2013. The service met the regulations we inspected against at that time.

This inspection took place over two days. The first visit on 11 February 2015 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 12 February 2015.

The home did not have a registered manager at the time of this visit. The former registered manager had voluntarily cancelled their registration in December 2014. A new manager had recently commenced working at the home and was going to apply to be registered as the 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.

During this inspection we found the provider had breached a regulation relating to the support and development of staff. This was because some staff had not received supervision or appraisals so they were not being offered support in their role. Also some staff had not been provided with training relevant to the needs of people who lived at the home. The provider had also breached a regulation relating to accuracy of care records. This was because some care records did not reflect the specific needs of people who used the service. You can see what action we told the provider to take at the back of the full version of the report.

People said they felt safe and comfortable at the home. Staff knew how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. Potential risks to people’s safety were assessed and managed. People’s medicines were managed in a safe way.

People told us there were enough staff to meet their care needs. Most people felt staff came quickly when they requested support, but a small number felt staff did not attend to them in a timely way. The manager was going to look into how staff were deployed. Staff were recruited in a safe way so that only suitable staff were employed.

Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision and deprivation of liberty safeguards to make sure they were not restricted unnecessarily. People’s safety was protected without compromising their rights to lead an independent lifestyle. Staff told us people had choice and control over their own decisions and lifestyle.

The building was designed to meet the needs of the people who lived there. Many people on the ground floor were living with significant physical disabilities and the accommodation was equipped to support their needs. There were some decorative shortfalls to bathrooms on both units which were in need of refurbishment. The regional manager said the funds to address these items had already been requested from the provider.

The people we spoke with felt staff were competent in their roles and they supported them in the right way. People’s comments included, “They know the job” and “they are very good”. People were supported to eat and drink enough to meet their nutrition and hydration needs. The menus were repetitive, but people told us they could ask the cook for alternative meals if they did not fancy the two main dishes at each mealtime. Dietetic services told us the staff were good at managing the specialist tube-feeding methods of those people with significant physical disabilities. Any changes in people’s health were referred to the relevant health care agencies.

People had positive comments about the “caring” staff. Many people described the care staff as “kind”. When asked about the care they received people commented, “I am really happy with it” and “I like this place, they do their best for us”. Relatives were also positive about the care people received. People and relatives felt the home was friendly and welcoming.

People and relatives told us there was a good range of activities at the home. Staff made sure people had the chance to go out shopping or to local places, including the church and pub. People had information about how to make a complaint or comment and these were acted upon. People and relatives said they could approach the new manager at any time and said she was approachable.

People and relatives felt the service was well run. One visitor commented, “The service is well managed for my [relative].” People felt they were asked for their views and opinions and there were regular residents’ meetings.

Staff told us they felt the manager was approachable and open to their views. There were regular staff meetings for staff to be kept informed of the standards of care and expected practices. The provider had a quality assurance programme to check the quality of the service, but commissioners had identified several gaps in records, training and support of staff. The new manager had begun to address these shortfalls but it was too early to check whether the planned improvements would be effective.

We spoke with three people who used the service and four relatives. Everyone we spoke with was positive about staff and the care they provided. One person said, 'Staff are very friendly and approachable.' Another person said, 'The food is very good'. One relative told us, 'Visitors are made to feel welcome.'

We saw that suitable arrangements were in place to obtain consent to care and treatment from people. People experienced care and treatment and support that met their needs and protected their rights.

We found there were sufficient numbers of suitably qualified staff to meet the needs of people. The provider had a system to regularly assess and monitor the quality of service that people received.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People told us about their experiences of being at the Victoria Lodge Care Home. People told told us the staff involved them in some aspects of the running of the home. Two people told us about the residents meetings and how the people who used the service used these meetings to make changes to menus, staffing and social activities.

The provider provided people with information about the home in the form of a brochure. The brochure contained information about the scale of charges, facilities in the home and also about staff and their qualifications.

People we spoke with told us they received regular medical care from their general practitioner, and also from other healthcare professionals such as dentists, opticians, chiropodists and dieticians.

These older reports are from our old approaches to inspection, including those from before CQC was created.

Archived: Victoria Lodge Care Home

All Inspections

26 October 2016

During a routine inspection

13 and 14 October 2015

During a routine inspection

11 and 12 February 2015

During a routine inspection

20 August 2013

During a routine inspection

29 May 2012

During a routine inspection

Reports under our old system of regulation