We carried out an unannounced inspection at Victoria Care Home on 21 and 22 January 2019.

Victoria Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection. At the time of the inspection, all people were accommodated on the ground floor. There were 20 people accommodated in the home.

The manager was appointed in October 2018 and was in the very early stages of registration with CQC, to become the 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 the last comprehensive inspection on 20 and 21 November 2017 and assessed the service as overall ‘requires improvement’. We identified four breaches of the regulations in respect of the management of medicines and complaints, the implementation of the Mental Capacity Act and the lack of effective quality assurance systems. We issued two warning notices in relation to the management of medicines and the governance systems. At this inspection, we found the provider had made the necessary improvements and they were compliant with the requirements of the notices.

This is the fourth time the service has been rated as requires improvement. However, there was an upward trend at the service and there were clear improvements since the last inspection. The provider was no longer in breach of the regulations. At this inspection, we have made two recommendations about improving people’s dining experiences and ensuring people are fully involved in the development and review of their care plan.

People using the service told us they felt safe and staff treated them with respect. Safeguarding adults’ procedures were in place and staff understood their responsibilities to safeguard people from abuse. Risks related to people's lives and wellbeing were assessed, monitored and reviewed to support people's safety. Risk assessments were detailed and contained information to help staff understand and manage any identified hazards. There were sufficient numbers of staff deployed to meet people's needs. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work with vulnerable adults. People received their medicines when they needed them from staff who had been trained and had their competency checked.

Staff had the knowledge and skills required to meet people's individual needs effectively. They completed an induction programme when they started work and were up to date with the provider's mandatory training. 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 supported this practice. People’s healthcare needs were monitored as appropriate and staff worked closely with social and healthcare professionals.

People were provided a varied nutritious diet and were offered a choice of food. However, the staff did not always provide effective supervision and there was limited social interaction. The manager had also identified the meal time arrangements as an area for development.

Staff treated people in a respectful and dignified manner and people's privacy was respected. We observed people were happy, comfortable and relaxed with staff. Individual care plans and risk assessments were reviewed on a regular basis; however, people were not always consulted about their care and were not involved in the reviews. People were encouraged to remain as independent as possible and were supported to participate

We carried out an unannounced inspection at The Victoria Residential Home on 20 and 21 November 2017.

The Victoria Residential Home 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. The care home accommodates up to 48 people on three floors. At the time of the inspection, there were 26 people accommodated in the home. There were no people accommodated on the top floor. The first floor of the home specialised in providing care and support for people living with dementia.

At the time of our inspection, the service did not have a registered manager 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. The previous registered manager had left the service in August 2017. The current manager had been in post since 25 September 2017.

At the last inspection on 6 and 7 June 2017, we asked the provider to take action to make improvements to management of medicines, the levels of cleanliness and the maintenance of people’s records. We also issued a warning notice in respect of the deployment of staff. Following the inspection, the provider sent us an action plan and told us they would make the necessary improvements by 31 October 2017.

During this inspection, we found the level of cleanliness had improved, the staffing levels had been increased and there had been some improvements in the maintenance of people’s care records. However, we identified there was a continued shortfall in the management of medicines and found two further breaches of the regulations in respect to the management of complaints and the governance systems to assess, monitor and improve the service. We also repeated our recommendation in respect to the implementation of the Mental Capacity Act 2005.

The home was rated as inadequate in February 2015 and requires improvement in June 2015 and June 2017. This is therefore the fourth occasion the provider has failed to meet the regulations.

People told us they felt safe and comfortable in the home. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. However, we saw no evidence of safeguarding investigations. Staffing levels had been increased and according to the rotas the level of staff was consistent across the week and weekend. However, on the first day of the inspection the senior staff allocated to the first floor was given other duties and was therefore not able to supervise the staff. Appropriate recruitment procedures were followed to ensure prospective staff were suitable to work in the home.

People’s medicines were not managed safely.

All areas of the home seen had a satisfactory level of cleanliness and there were arrangements in place for the maintenance and upkeep of the premises.

There was a system in place for recording accidents and incidents. However, there were no records seen for June, July and August 2017 and there was no analysis seen of incidents, which occurred during this time. Further to this, the provider sent us copies of monthly analysis forms for this period on 10 January 2018. We were also informed the manager was analysing the data for any potential trends.

Staff told us they were provided with appropriate training, however, the staff training matrix was not up to date. This meant it was difficult to determine what training staff had completed. Staff felt supported by the manager; however, some staff had not received a supervision since our last inspection.

People had choice and control over their lives and staff supported them to be indepen

We carried out an inspection of The Victoria Residential Home on 6 and 7 June 2017. The first day was unannounced.

The Victoria Residential Home is registered to provide accommodation and personal care for up to 48 older people. The home is a converted hospital set in its own grounds within a close distance of Burnley town centre. Accommodation is provided on three floors, however at the time of the visit there was no one living on the top floor. The ground floor provides personal care for older people and the first floor provides care for people living with dementia. The home is spacious and has car parking facilities at the front of the building. At the time of the inspection there were 32 people living in the home.

The service was managed by 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.

On our last inspection on 14 and 15 July 2015, we found one breach of the regulations. This was because the information in people’s care plans was brief and lacked detail. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulation. During this inspection, we found some improvements had been made and the registered manager had implemented a new care planning system. However, we also found a number of shortfalls in the management of medicines, the deployment of staff, the levels of cleanliness and the maintenance of records. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concern found during inspections is added to reports after any representations and appeals have concluded. We also made recommendations about the implementation of the Mental Capacity Act 2005, improving some aspects of the internal and external environment and ensuring evidence is available to demonstrate the quality monitoring checks undertaken by the provider.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse. Individual risks had been assessed and documented; however, we found information from the risk assessments was not always reflected in people’s care plans. This is important to ensure staff have accurate information about people’s current needs. Since our last inspection, the registered manager had introduced a new care planning system. We noted that wherever possible people had been involved in planning their care.

There were shortfalls in the management of medicines. We noted medicines were not always stored, administered and disposed of appropriately.

We noted there were insufficient staff deployed on the ground floor in order to meet people’s needs in a timely manner. The provider followed a robust recruitment procedure for the appointment of new staff. Staff were supported in their roles via a system of training, supervision and appraisal. All staff had the opportunity to attend meetings and provide feedback on the service. Staff spoken with told us they were well supported and had confidence in the registered manager.

Mental capacity assessments had been carried out and the registered manager had submitted Deprivation of Liberty Safeguard applications to the supervisory body. However, we found the assessments were not always person centred and lacked information about specific decisions.

Some areas of the premises and equipment did not have an acceptable level of cleanliness.

We observed people did not always receive appropriate support at meal times and people had mixed views on the quality of the food. The meal served on the day of the inspection loo

We carried out this inspection to follow up compliance actions set out our previous inspections on 11 June 2013 and 1 July 2013. We found the necessary improvements had been made and the provider was compliant with the outcomes assessed.

People spoken with were satisfied with the service provided, one person told us, “I feel very well looked after and have no worries at all”. A relative spoken with was also complimentary about the service.

People’s care was planned and delivered in accordance with their needs. People had individual care plans which were supported by a series of risk assessments. A new care plan format had been implemented, which provided more information for staff on people’s needs and preferences.

People were provided with a variety of suitable and nutritious meals. People were given a choice each mealtime and we noted drinks and snacks were served throughout the day as well as other times on request.

The provider had notified the commission as necessary in line with the current regulations.

Since January 2013 the home has been subject to an extensive building and refurbishment programme. We carried out this inspection to assess the newly refurbished first floor.

We found the refurbished areas met with regulatory requirements and the manager explained the safety arrangements in place for the planned refurbishment of the ground floor. People had been consulted about moving from the ground to the first floor.

Prior to the inspection, we received a report from the fire authority to confirm the fire safety arrangements were satisfactory. During the visit we looked at safety certificates for the electrical installations and the call system.

Having seen the safety documentation and viewed the first floor accommodation, we had no objections to the 11 people accommodated in the home moving to the first floor.

We carried out this urgent responsive inspection following the receipt of concerning information from the Environmental Health Department. We visited the home with Environmental Health Officers on the same day we received the information.

During the inspection, it was established there was a waste pipe from the kitchen discharging water into the cellar and an infestation of vermin in the same area. There had been no sightings of vermin in the main building.

Whilst arrangements were made to rectify these problems, we were concerned we had not been notified of these events in line with the Regulations. This is essential so we can ensure the provider has taken appropriate action to safeguard the people living in the home.

This was our first inspection of the home following a change of ownership. Over the last six months there has been significant building work to improve and refurbish the home. We found appropriate arrangements were in place to minimise any disruption to the current residents.

People told us they were generally satisfied with the service provided. One person said, “I think this is a lovely place” and another person commented, “I don’t have any complaints”.

Each person had a plan of care which was designed to provide guidance for staff on how best to meet people’s needs. Staff spoken with told us the plans were easy to follow. However, we found not all aspects of need were covered in the care plans.

People told us the food was generally “alright” and said they enjoyed their meal on the day of our visit. However, we found there were limited communication systems between the cook and the staff, which meant the cook may not have been fully aware of people’s dietary needs and preferences. We also found the menus sometimes offered limited choices. The manager informed us the menus were due to be reviewed and she was working on improving the kitchen arrangements.

Staff were provided with appropriate training opportunities and received regular supervision. Staff told us they were well supported in their role.

There were systems in place to monitor and assess the quality of the service, which included gathering the views of people living in the home.

We carried out an unannounced inspection of The Victoria Residential Home on 14 and 15 July 2015. The Victoria Residential Home is registered to provide accommodation and personal care for up to 45 older people and people living with dementia.. The service does not provide nursing care. At the time of the inspection there were 24 people accommodated in the home.

The home is a large Victorian style property set in its own grounds and is within close distance to Burnley Town Centre. Accommodation is provided in single occupancy rooms. The upper floors can be accessed via a passenger lift. The home is spacious with adapted facilities throughout to support people maintain their independence. There is parking at the front of the building for visitors.

The service had a registered manager in post. A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run.

At the previous inspection on 24 and 27 February 2015 we found the service was not meeting all the regulations and there were significant deficiencies in the delivery of the service We asked the registered provider to take action to make improvements in respect of person centred care, dignity and respect, need for consent, safe care and treatment, premises and equipment, good governance and staffing.

During this inspection visit we found there had been significant improvements. However we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to the training and development of staff and person centred care. You can see what action we told the registered provider to take at the back of the full version of the report.

We found there had been some improvement in the training of staff. However not all staff had received essential training and formal supervision to give them skills and knowledge and support them care for people in a safe and effective way. We have made a recommendation regarding this.

People we spoke with told us they had their medicine when they needed it. We found medicines were generally managed well and appropriate arrangements were in place in relation to the safe storage, receipt, administration and disposal of medicines. However we found topical medicines were not being recorded as being applied and we made a recommendation about this.

At the last inspection we found wheelchairs belonging to people were being used for others. We found people requiring wheelchairs had been issued with their own and these were clearly labelled with their names on. However despite this we noticed one person’s wheelchair was used for another person. We have made a recommendation regarding this.

We found identified risk was generally managed well. However we noted guidance on the management of behaviour that challenged others was not recorded adequately to ensure a consistent approach was taken by staff. We have made a recommendation about this.

We looked at issues relating to the management of person centred care in relation to continence management, personal hygiene needs and skin integrity. You can see what action we have asked the provider to take at the back of this report.

People we spoke with told us they felt safe at the home. They commented, “I like the staff. There's not one that I don't like. They feed me well and look after me. I'm looked after very well.” “I am treated very nicely. The staff are lovely people, I feel safe living here.” Some people could not express their views and family members spoke on their behalf. On relative told us, “I feel confident that Mum is well looked after, the staff are all great. They're all very approachable.”

Staff had an understanding of abuse and most staff had received training on safeguarding people. The registered manager had made appropriate safeguard referrals regarding this. However over half the staff employed had not received training about the Mental Capacity Act 2005 (MCA 2005) and Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care. This meant staff may not recognise when people were being deprived of their liberty and ensure best interest decisions were being made.

Staff were made aware of people’s dietary preferences and of any risks associated with their nutritional needs. We saw appropriate professional advice and support had been sought when needed and people’s weight was generally checked at regular intervals. We saw people being sensitively supported and encouraged to eat their meals. Meals served were nutritionally balanced and portions served were generous.

People’s healthcare needs were managed well and routine healthcare screening planned for. People told us staff made arrangements for their GP to visit if they were unwell. The service had developed good working relationship with health care professionals.

We saw people were treated with dignity and respect. Staff were considerate and treated people with kindness in their day to day care. These values were written into care plans and people using the service had been involved in making decisions about their care. Dignity issues such as gender of carer was acknowledged and respected. We were told the information in people’s care records was being improved to be more person centred and to reflect more of people’s preferences and routines.

People had an opportunity to discuss their end of life wishes. This gave people the opportunity to have peace of mind knowing their wishes were made known to everyone and to make sure they have dignity, comfort and respect during this stage of their life.

We observed good relationships between people living in the home and staff. Throughout the day we heard friendly chatter between staff and people using the service. We noted staff spending time to sit and chat with people in a friendly, relaxed and natural way. People recalled their activities such as trips out and everyone we spoke with expressed delight in the cinema.

The complaints procedure was displayed in the home and we found processes were in place to record, investigate and respond to complaints. This supported people to have confidence their concerns would be taken seriously. People could access advocacy services if they wanted support and advice from someone other than staff.

People using the service did not express any concerns about the management and leadership arrangements. The registered manager operated an ‘open door policy’, which meant arrangements were in place to promote on-going communication, discussion and openness. The registered manager expressed commitment to the on-going improvement of the service. We saw improvements were on-going and an action plan was in place to address any shortfalls in service delivery .

There were systems and processes in place to consult with people who used the service, other stakeholders and staff.