Victoria Lodge

Victoria Lodge is a residential care home providing personal care to up to 23 people. The service provides support to older people, most of whom were living with dementia. At the time of our inspection there were 17 people using the service.

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

People told us they felt safe and were comfortable to speak with staff or management if they had any concerns. Staff received safeguarding training and demonstrated their understanding on the prevention and reporting of abuse.

People received their medicines safely by staff who were trained and competent to administer them. Staff practiced good infection control to help protect people from the COVID-19 pandemic. Risks to people’s health and the environment were assessed and managed safely.

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. People and their relatives were involved in the planning and reviews of their care. People were given choices and asked for their opinion of the service and support they received. One person told us, “I would not want to change anything. Food is good they asked my opinion on what I want.”

People were supported by staff who upheld their dignity and encouraged their independence. Staff supported people to remain in control of their lives. One staff member said, “We check if they can manage on their own, if they need help, we get consent and help them.”

People and their relatives gave positive feedback about the staff. One relative said, “There appears to be quite a lot of love there.” A person told us, “The girls and the boys here all very helpful I can't say I have a favourite they are as nice as each other.”

People, their relatives and staff told us they felt comfortable to make suggestions or complain and confirmed the management team would deal with any problems. Relatives told us staff and management kept them up to date. Comments included, “The best thing is that they keep in touch with me.” People and their relatives spoke positively about the running of the service. One person said, “My family live near, they come to visit as much as they can, it's really nice to see them. They are made very welcome by the staff and comment on how clean this place is.”

People were appropriately referred where professional advice was needed. Staff and the management team worked closely with them to improve people’s care, safety and well-being. One relative told us, “They have a good relationship with the surgery. They seem to always get a doctor or nurse to check [person] over. The falls team are coming out.” A visiting professional commented, “They do well, they are very responsive to the patients needs.”

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 12 February 2019).

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 received concerns in relation to safeguarding matters which had been raised. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

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 good based on the findings of this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, caring and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Victoria Lodge is a residential care home registered to provide accommodation and care for up to 23 people, the majority of whom have a diagnosis of dementia and/or other care needs. At the time of our inspection, 21 people were living at the home. Communal areas include a sitting room, dining room/conservatory and access to a rear garden. Accommodation is over three floors and is serviced by a lift. Victoria Lodge 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 care provided and both were looked at during this inspection.

A registered manager was in post. 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.

Following the last inspection, the service was rated as 'Good' overall, with 'Requires Improvement' under 'Effective'. At the last inspection in May 2016, we asked the provider to take action to make improvements in relation to staff training, supervision and appraisal. Improvements had been made in these three areas and the service remains rated 'good' overall.

Notifications that the provider was required to send to us by law had not been done in relation to Deprivation of Liberty Safeguards authorisations. Records such as Medication Administration Records (MAR) had not always been completed accurately. Information relating to prescribed medicines on MARs had been hand-written by a member of staff, but had not been checked by another member of staff in line with the service's quality assurance process or National Institute for Clinical Excellence guidelines. The services quality assurance processes had not picked these omissions up and therefore is an area that requires improvement.

Some information was provided in an accessible format and the registered manager informed us this was work in progress. Activities were organised for people.

Staffing levels were consistent, Staff commented on how busy it could be at certain times of the day.

Staff knew how to keep people safe and had completed training in safeguarding adults at risk. A range of risk assessments had been completed in relation to people and premises. New staff were recruited safely. The home was clean and tidy and staff had completed training in infection control.

Staff completed a range of mandatory training and were encouraged to study for vocational qualifications. Menus for people were planned in line with their dietary needs, likes and dislikes. Drinks were freely available. People received support from a variety of healthcare professionals. 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 service support this practice.

People were looked after by kind and caring staff who knew them well. As much as they were able, people were involved in day-to-day decisions and choices. Staff were reassuring and friendly with people and treated them with dignity and respect.

Care plans were detailed and written in a person-centred way. Activities were organised for people and there were plans to employ an activities co-ordinator. Complaints were managed in line with the provider’s policy.

Staff were involved in the development of the service and their feedback obtained through staff meetings. Employee satisfaction surveys had been completed by staff to gain their views about working at the home. Compliments from relatives were received and recorded. Residents’ meetings took place and people were asked for their views and suggestions about the home. The registered manager had involved the services of a consultant to advise them on how an outstanding rating could be achieved.

Victoria Lodge is registered to provide care for up to 23 people older people who are living with dementia. At the time of our inspection, 17 people were living at the home. Victoria Lodge is situated close to the town centre of Worthing and within walking distance of the seafront. Accommodation is provided over three floors and all rooms are of single occupancy; some have en-suite facilities. There is a large sitting room and adjacent conservatory, the latter also used as a dining area. People have access to an attractive rear garden with seating areas.

A registered manager was in post. 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.

Staff had not received specific training on the requirements of the Mental Capacity Act 2005 and did not understand their responsibilities under this legislation. Some staff had not completed or updated their training in all essential areas. Staff had supervision meetings, but formal meetings or annual appraisals were not planned on a regular basis.

Staff understood how to gain people’s consent before delivering their care and involved people in day-today decisions. Coded keypads around the home prevented people from leaving the building or accessing some parts of the home without staff support, which was for their safety. People had sufficient to eat and drink and were encouraged to maintain a balanced diet. They had access to a range of healthcare services and professionals. The home was undergoing refurbishment.

People and their relatives felt the home was a safe place. Staff understood how to protect people from the risk of abuse and knew what action to take if they suspected abuse was happening. People’s risks had been identified and assessed and were managed appropriately. There were sufficient numbers of staff on duty to keep people safe and meet their needs. Safe recruitment practices were followed. The home was clean and there were no unpleasant odours.

People were looked after by kind and caring staff who knew them well. People were encouraged to be involved in all aspects of their care and they were treated with dignity and respect.

Care plans were person-centred and provided detailed information and guidance to staff about people’s care needs, including their personal histories, likes and dislikes. A range of activities were available to people and the provider was planning to increase the number of organised activities delivered by an external activities co-ordinator. Complaints were managed appropriately in line with the provider’s policy.

People were asked for their views about the service and the registered manager had individual meetings with people to obtain their feedback. Staff felt supported by the management team and the registered manager spoke highly of the provider. A range of audit systems was in place to monitor the quality of care delivered and the service overall.

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

Our inspection team comprised two adult social care inspectors. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people who used the service, one person visiting a friend, four staff supporting them and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

We saw that care and treatment was planned and delivered in a way that ensured risks were appropriately assessed and support provided to mitigate risks. One person told us, 'Yes, I feel safe'.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told that no applications have needed to be submitted, but the manager, who had recently come into post, was in the process of reassessing people to ensure that appropriate arrangements were in place.

Recent improvements to the premises meant that people were cared for in a suitable environment. For example, the call system was being upgraded so that staff would know on the ground floor if people needed assistance on the top floor. We saw that suitable fire evacuation procedures were in place and that fire equipment was fit for purpose.

Staff had received training which enabled them to look after people safely.

Is the service effective?

People told us that they were happy with the care that had been delivered and that their needs had been met. One person said that staff checked with them, 'Would you like to dress now. It's very optional'. We saw that people were consulted about their care and treatment and that, where possible, their relatives had also been involved. Relatives had, in some cases, provided life histories of people so that staff were able to chat with them about things that were personal to them.

There was a choice of food available to people on a daily basis and where people required special diets, we saw these were catered for.

Is the service caring?

People had a keyworker who was the link between that person, any visitors and health professionals. A member of staff told us that, 'Everyone gets involved'. People we spoke with felt cared for. One person described how they had been able to go out and said, 'Staff take me out for a walk in the chair. We went out at 1.30 pm and didn't get back until 5.00 pm. We were searching for hats, so we can go out and sit in the garden. It was very nice'.

We heard one person reminiscing about the war with a member of staff who was keen to hear about an air raid shelter built in their garden.

Is the service responsive?

We saw that there was a range of activities available to people who used the service. One person said, 'We have special classes and activities' and another conformed that there were all sorts of different activities on offer.

During the lunch period, we saw that a person did not like the food on offer and that they were offered an alternative of a cheese omelette, which they accepted.

We saw that advice was sought from other health professionals when required, for example, when one person had suffered a loss in weight and needed a change of diet. The catering arrangements for this person had been changed to accommodate their changed needs.

Is the service well led?

The staff we spoke with were clear about their roles and responsibilities and had opportunities to obtain further qualifications if they wished. Staff views were sought through regular supervisions and yearly appraisals. Staff we spoke with said they felt supported by management and were asked at supervision, 'Do you feel valued?'. Another member of staff told us that they were consulted about any improvements that they wanted to suggest and said the management were, 'Very supportive, everything you ask for they try to get'.

We saw that there were effective systems in place to regularly assess and monitor the quality of service that people received.

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were detailed care and support plans in place for people who used the service. Staff supported people as individuals and at an appropriate pace. Risks had been identified although the recording of incidents and accidents was not easy to understand.

At the time of this inspection the service did not have a registered manager.

During this inspection we looked at the care records of three people. We spoke with the provider and four staff members.

We saw evidence that people's individual needs had been assessed and that care was planned in order to meet these needs. The staff we spoke with were able to demonstrate they understood the care needs of the people who lived at the home. We also saw that risk assessments and care plans were reviewed to reflect people's current needs. This meant that arrangements were in place to ensure people experienced safe and appropriate care.

There was no registered manager in post at the time of this inspection.

We spoke with two staff members and reviewed the medication records of all the people who lived at the home. We found evidence that medicines were not always administered in a safe and consistent way. We also found that appropriate arrangements for the recording of medicines administered were not in place. The provider did not have accurate records of the stock of controlled and there were no audits undertaken of medicines management. This meant that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

At the time of this inspection the provider did not have a registered manager in post.

We spoke with six members of staff. They told us they liked working at the home. One described it as "Really homely." and, "More of a home than a care home." They said they felt well supported in their roles but had not received any regular formal supervision. The training records we looked at showed that not all staff had up to date mandatory training.

We looked at the care records of five people. We found evidence to show that the planning and delivery of care did not always meet people's individual needs or ensured their safety and welfare. This meant people did not always receive effective, safe and appropriate care. We also found that people were not provided a choice of suitable and nutritious food and that they were not always protected from the risks of inadequate nutrition.

The provider did not have arrangements in place to monitor the quality of service that people received. Risks to the health, safety and welfare of people who used the service were not monitored or managed.

We spoke with four people who used the service. People told us that staff supported them to a high standard and their needs were met.

We found the home had appropriately assessed people's needs and potential risks. We found that people were protected from the risk of inappropriate care.

We found that people's prescription medications were stored securely and a record of medication administration was maintained. People were well supported with their medications.

We found that the provider had recruitment and vetting procedures in place to ensure people were supported by staff who were adequately skilled and had necessary checks.