Victoria Grand

Victoria Grand is a residential care home providing accommodation and personal care for up to 26 people. The service provides support to older people, people with dementia and younger adults. At the time of our inspection there were 13 people using the service. The care home accommodates people in an adapted building over 3 floors, there is a lift to connect the floors.

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

There were not always enough suitable staff to provide safe and effective care to meet people’s needs, including at night-time and for social support.

Risks to people were not always identified, assessed or managed effectively. Some people needed support with mental health needs and expressing feelings of distress or agitation. Staff did not have clear guidance about the level of risk and strategies to provide care safely. Medicines were not always managed safely because some protocols lacked detail to ensure staff had the information they needed when they administered medicines. Environmental risks and infection prevention and control risks were not always identified and managed. This meant there were increased risks of avoidable harm to people.

People were spending the majority of their time in their rooms, and some reported feeling isolated, bored and lonely. A person said, “I can spend hours and hours on my own.” Another person told us, “I am in my room a lot of the time, in fact most of the time.” Organised activities happened for a few hours on 2 afternoons a week. People said they saw no point in leaving their rooms because there was nothing to do. Staff told us they were too busy to spend time with people.

Care was task focused and care plans did not always support a personalised and holistic approach. Some people had mental health needs, but records did not reflect the support they needed. Staff told us they knew people well and this mitigated risks to some extent, but the lack of personalised records meant the provider could not be assured that people were receiving the care they needed and new or unfamiliar staff did not have all the information and guidance to support people.

Systems for assessing the quality and safety of the service were not all effective and robust. Audits had been undertaken on a regular basis but did not always identify shortfalls to drive improvements. A lack of effective leadership and management systems, including contingency plans, were not robust and this meant safe staffing levels were not maintained.

Staff understood their responsibilities for safeguarding people. People told us they felt safe living at the home, and they described kind and caring staff. 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 CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 31 October 2018).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and the management of the home. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

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.

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 changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. Following this inspection, the provider confirmed that they had taken action to make improvements.

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

Enforcement

We have identified breaches in relation to staffing, risk management, person-centred care which includes meeting people’s social needs, and leadership and management 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 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 Victoria Grand is registered to provide care and accommodation for up to 26 older adults in one adapted building. People at the home are living with dementia and physical needs. At the time of our visit there were 18 people living at the Victoria Grand.

Victoria Grand 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 service was last inspected in September 2016. At our last inspection we rated the service as overall good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Since our last inspection, we have continued to engage with the provider. At the last inspection the provider was unable to demonstrate that care and treatment had been provided with the consent of the relevant person in line with the Mental Capacity Act 2005. We required the provider to complete an action plan to show what they would do and by when to improve the key question, is the service effective, to at least good. At this inspection, the registered manager was able to demonstrate that care and treatment had been provided with the consent of the person. We confirmed the provider had taken sufficient action to address the previous breach of Regulation.

We found although care and treatment was being provided with the persons consent, how decisions were being made were not always documented. We found guidance on as and when needed medicines and risk assessments lacked detail. Improvements were needed to the recording and documenting of information, but we did not see this having an impact for people.

Risks to people were identified, assessed and measures were taken to manage those risks. People told us there were enough staff to meet their needs. Staff were able to demonstrate how they keep people safe from abuse and safe in an emergency. Staff were well trained and received regular supervisions.

People's medicines were managed safely and administered by staff who had received specific medicine training. The home followed safe staff recruitment practices and provided a thorough induction process to prepare new staff for their role.

Staff were observed to be caring and to have kind supportive relationships between staff and people. Staff promoted people’s dignity, respected their privacy and promoted their independence.

People were given opportunities to be involved and supported to express their views on how they wished to be cared for. Staff and relatives told us they are involved in decisions made, relatives told us they are involved in decisions affecting their relative and health professionals were involved. People and their relatives knew how to raise a concern and felt able to do so.

People received personalised care by staff that knew them well. People were offered a choice of activities. The culture of the home was caring, positive and friendly. Staff and people spoke positively about the registered manager.

Victoria Grand is registered to provide accommodation and personal care for up to 26 people. At the time of the inspection 21 people were living at the home, this included two people staying on short breaks. People had various needs including dementia and physical disabilities.

Victoria Grand is an older styled detached property situated close to the centre of Worthing with easy access to shops and the seafront. Some areas of the home, including the entrance and dining area had been decorated and were warm and inviting. There was an action plan in place which included areas of the home which remained in need of decorating. The house was surrounded by additional space including a large attractive garden to the side of the building. All bedrooms were personalised and single occupancy and had en-suite facilities.

A registered manager was in post at the time of our inspection who had managed the service for many years. 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.

The registered manager was unable to demonstrate that the Mental Capacity Act 2005 (MCA) had always been followed because capacity assessments had not been completed by staff on behalf of people. Best interest meetings were held in line with the (MCA) and the Deprivation of Liberty Safeguards (DoLS) legislation for one person who lacked capacity to make decisions over their care. However, this practice was not consistent as this had not been considered for another person who was deemed to lack capacity to make a decision regarding the use of bed rails on their bed. The registered manager was able to tell us the action she had taken with regard to this.

People and their relatives told us the home provided a safe service and there was enough staff to meet people’s needs. Staff were able to speak about what action they would take if they had a concern or felt a person was at risk of abuse. Risks to people had been identified and assessed and information was provided to staff on how to care for people safely and mitigate any risks.

People’s medicines were managed safely and administered by staff who had received specific medicine training. The home followed safe staff recruitment practices and provided a thorough induction process to prepare new staff for their role.

Staff implemented the training they received by providing care that met the needs of the people they supported. Staff received regular supervisions and spoke positively about the guidance they received from the registered manager.

People could choose when, where and what they wanted to eat. Additional drinks and snacks were observed being offered in between meals and staff knew people’s preferences. Staff spoke kindly to people and respected their privacy and dignity. Staff knew people well and had a caring approach.

People received personalised care. Care plans reflected information relevant to each individual and their abilities, including people’s communication and health needs. Staff were vigilant to changes in people’s health needs and their support was reviewed when required. If people required input from other health and social care professionals, this was arranged. People were offered activities to attend within the home. All complaints were treated seriously and were overseen by the registered manager.

People were provided opportunities to give their views about the care they received from the service. Some people chose to use these opportunities to become more involved with their care and treatment. Relatives were also encouraged to give their feedback on how they viewed the service.

Staff understood their role and responsibilities. The registered manager demonstrated a ‘hands-on’ approach and knew people well. They had implemented a range of quality audit processes to measure the overall quality of the service provided to people and to make improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Records showed that there was current and on-going monitoring of the service to demonstrate the quality of the service provided. This demonstrated that the provider had an effective system to assess and review the service.

People told us that there were systems in place to raise issues and address them.

We saw that the care records were current, accurate and fit for purpose.

People also told us that they were satisfied with the care and attention shown by staff. This showed us that people experienced care, treatment and support that met their needs and protected their rights. Records were seen that showed us that ongoing monitoring and assessment of the quality of the services being provided had taken place in this service.This meant that the provider had an effective system to regularly assess and monitor the quality of service that people receive.

People told us that if they had any concerns these would be addressed promptly by staff. This meant that there was an effective complaints system in place. We saw that the care records kept were accurate and fit for purpose. This showed us that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.