We carried out a comprehensive inspection of Victoria House on 5, 7 and 8 November 2018. The first day was unannounced.

Victoria House is registered to provide accommodation and personal care for up to 15 older people. Accommodation is provided over two floors, with two lounges and a separate dining room . At the time of our inspection there were 10 people living at the home. However, only eight people were available to speak with us, as two people were in hospital.

The service 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 we looked at both during this inspection.

At the time of the inspection, there was a registered manager in place who was responsible for the day to day running of the home. 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 to service is run.

At the last inspection on 19 and 20 September 2017, we found one breach of the regulations. This related to a failure to ensure that the needs of people living with dementia or a sensory impairment were being met. Following our inspection, the provider sent us an action plan and told us that all actions had been completed.

At this inspection we found that the necessary improvements had been made and the provider was meeting all regulations reviewed. We have made a recommendation about the need for the provider to ensure that staff have the knowledge and skills necessary to meet people’s needs and provide them with safe, effective care.

People living at the home and their relatives were happy with staffing levels and told us people never waited long when they needed support.

We observed people receiving their medicines safely and found that there were appropriate medicines policies and practices in place.

We found evidence that staff had been recruited safely and the staff we spoke with understood how to protect people from abuse or the risk of abuse.

People told us they were happy with the activities and entertainment provided at the home. We found that the activities and stimulation available for people living with dementia or a sensory impairment had improved since the last inspection.

Staff received an effective induction and appropriate training. Most people who lived at the service and their relatives felt that staff had the knowledge and skills to meet people’s needs. However, one person told us that not all staff knew how to support her to manage her health condition. We discussed this with the registered manager who addressed the issue with staff.

People told us the staff who supported them were caring and respected their right to privacy and dignity. We observed staff encouraging people to be independent when it was safe to do so.

People received appropriate support with their nutrition, hydration and healthcare needs. Referrals were made to community healthcare professionals to ensure that people received appropriate support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way; the policies and systems at the service supported this practice. Where people lacked the capacity to make decisions about their care, the service had taken appropriate action in line with the Mental Capacity Act 2005.

People told us that they received care that reflected their needs and preferences and we saw evidence of this. Staff told us they knew people well and gave examples of people’s routines and how they liked to be supported.

Staff communicated effectively with people. People’s communication needs were identified and appropriate support was provided. Staff suppor

We carried out a comprehensive inspection of Victoria House on 19 and 20 September 2017. The first day of the inspection was unannounced.

Victoria House provides care and accommodation for up to 15 older people. Accommodation at the home is provided on two floors and there are accessible toilet and bathroom facilities on both floors. The service is situated in Brierfield, Nelson in East Lancashire. At the time of our inspection there were 11 people living at the home.

At the time of our inspection the service had a registered manager who had been in post since 2011. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected the service on 7, 13 and 14 March 2017, when we found breaches of five of the regulations relating to infection control, the management of medicines, the management of people’s risks, compliance with the Mental Capacity Act 2005, staff training and monitoring of the quality of the service. We issued warning notices in relation to two of the breaches and the provider was required to become compliant by 2 June 2017. We also made recommendations about staffing levels at the home and the activities available for people living with dementia. Following that inspection the provider sent us an action plan detailing the improvements they would make.

During this inspection we found that significant improvements had been made. However, it is necessary for the provider to provide evidence that the improvements made are being sustained over time. We found a breach of our regulations relating to person centred care, as further improvement was needed to ensure that the needs of people living with dementia or a sensory impairment were being met. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection we found that there were safe processes and practices in place for the management of people’s medicines. People told us they received their medicines when they should.

The people we spoke with told us they received safe care. Staff understood how to safeguard vulnerable adults from abuse and the appropriate action to take if they suspected that abuse was taking place.

Most people who lived at the home were happy with the staffing levels. The staff we spoke with felt that staffing levels were appropriate to meet people’s needs.

We saw evidence that the registered manager followed safe recruitment processes when employing new staff.

We found that people’s risks had been assessed and were reviewed regularly. This meant that staff were kept up to date with any changes in people’s needs and risks.

People told us they felt staff had the knowledge and skills to meet their needs. Staff told us they completed regular training and the records we reviewed confirmed this to be so.

Records showed that staff received regular supervision. Staff told us they could raise concerns and make suggestions during their supervision sessions.

Staff understood the main principles of the Mental Capacity Act, 2005 (MCA) including the importance of providing people with the information to make decisions and respecting people’s right to refuse care. The registered manager had submitted the relevant applications to the local authority, where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe.

People living at the home were happy with the quality and choice of the meals provided.

We found that people received support with their healthcare needs and appropriate referrals had been made to community healthcare professionals.

We observed staff supporting people sensitively and offering reassurance when people were upset or confused

We carried out a comprehensive inspection of Victoria House on 7, 13 and 14 March 2017. The first day of the inspection was unannounced.

Victoria House provides care and accommodation for up to 15 older people. Accommodation at the home is provided on two floors and there are accessible toilet and bathroom facilities on both floors. The service is situated in Nelson in East Lancashire. At the time of our inspection there were 12 people living at the home.

At the time of our inspection the service had a registered manager who had been in post since 2011. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The service was last inspected on 15 January 2015, when we found two breaches of our regulations relating to infection control and the management of medicines. Following that inspection the provider sent us an action plan detailing the improvements they would make.

During this inspection we found that further improvements were needed in relation to infection control and medicines. We also found breaches of our regulations relating to the management of people’s risks, a lack of appropriate staff training, a lack of compliance with the Mental Capacity Act 2005 and a lack of effective audits. You can see what action we told the provider to take at the back of the full version of the report.

As part of this inspection we have also made recommendations about staffing arrangements at the home and meeting the needs of people living with dementia.

During our inspection we found that people’s medicines were not always managed safely. Medicines were not always stored securely and temperatures where they were stored were not monitored.

People who lived at the home told us the home environment was safe and they received safe care. The staff we spoke with understood how to safeguard vulnerable adults from abuse and what action to take if they suspected that abusive practice was taking place.

People who lived at the home were happy with the staffing levels. However, some staff felt that staffing arrangements at the home needed to be improved.

We found that the service did not always follow safe recruitment practices. A member of staff was working at the home prior to the necessary checks being completed.

We found that people’s risks, such as their risk of falling or malnutrition, were not always managed appropriately and care plans and risk assessments were not always updated when people’s needs changed. This meant that it was difficult to ensure that people’s needs and risks were being managed effectively.

People told us they felt staff were able to meet their needs. We found that staff did not always receive an appropriate induction or up to date training.

Records showed that staff received regular supervision. However, staff told us that they did not always feel listened to or supported by the registered manager.

Staff understood the main principles of the Mental Capacity Act, 2005 (MCA) including the importance of gaining people’s consent and their right to refuse care. The registered manager had not submitted the relevant applications to the local authority, where people lacked the capacity to make decisions about their care and needed to be deprived of their liberty to keep them safe.

People living at the home were happy with the quality of the food provided. They told us they had plenty of choice at mealtimes and we saw evidence of this during our inspection.

We received positive feedback about the home from community healthcare professionals and we found that people received support with their healthcare needs. However, we found that appropriate action had not always been taken when there were issues with people’s weight loss and nutrition.

We obser

We carried out an unannounced inspection of Victoria House on 15 January 2015. Victoria House is registered to provide accommodation with personal care for up to 15 people. The service does not provide nursing care. At the time of the inspection there were 12 people accommodated in the home. An adult social care inspector conducted the inspection.

Victoria House is an older type detached two-storey property in a residential area on the outskirts of Brierfield. There is chair lift access to both floors. Bedrooms have wash basin facilities with toilet and bathrooms located nearby. There are two comfortable lounges and a dining room. There is parking to the front of the house and on the road.

At the previous inspection on 8 January 2014 we found the service was meeting all standards assessed.

There was a registered manager in day to day charge of the home. 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 found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, relating to medicines management and infection control arrangements.

We looked at how the service managed people’s medicines. We found processes were in place for the ordering, receipt, storage, administration and disposal of medicines and medication was stored securely. However, we found improvements were needed to ensure people’s medicines were handled safely. Staff training was not recorded and there were no assessments to ensure staff were competent and safe to manage people’s medicines. There were no assessments to support one person who was administering their own medicines or to support a decision to ‘disguise’ medicines in another person’s food. Medicines for disposal were not witnessed and people had not given consent for staff to manage their medicines. You can see what action we told the provider to take at the back of the full version of the report.

The home was clean and odour free and appropriate protective clothing, such as gloves and aprons, were available. However, there were no cleaning schedules or audit systems in place to support good practice. Staff had not been provided with training in infection control and there was no designated or qualified infection control lead person for the service. We found paper towel dispensers were needed in the toilet areas and improvements were needed to the flooring and exposed pipes in the laundry. We shared our concerns with the local authority infection control lead nurse. You can see what action we told the provider to take at the back of the full version of the report.

People told us they did not have any concerns about the way they were cared for and during the inspection we did not observe anything to give us cause for concern about people’s wellbeing and safety. One person said, “I am safe here; they will look after me.” Staff had an understanding of abuse and were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice.

We found there were sufficient numbers of suitable staff to attend to people’s needs and keep them safe. We noted calls for assistance were responded to in a timely way. We found a safe and fair recruitment process had been followed and appropriate checks had been completed before staff began working for the service.

Staff were given support and received a range of induction and training to give them the necessary skills and knowledge to help them look after people properly. However, we found the training records were not up to date. People made positive comments about the staff. Comments included, “Staff are very nice” and “The staff are very friendly.”

During our visit we observed people being asked to give their consent to care and treatment by staff. However, people’s capacity to make safe decisions and choices about their lives was not always clearly recorded in the care plans; the registered manager told us she would review this.

We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere was relaxed with friendly banter between staff and people living in the home. Staff spoken with had a good knowledge of the people they supported. People said their privacy, dignity and independence were respected. One person said, “They are very nice and talk to me properly.”

People were given the support they needed at mealtimes and were offered alternatives to the menu. The meals served looked appealing and plentiful and the dining tables were appropriately and attractively set. One person said, “The meals are very good, you can have what you want. If you don’t like what is on the menu you can have something else.”

Each person who lived at the home had a care plan that was personal to them. The care plans included good information about the support people needed and arrangements were in place to monitor and respond to people’s health and well- being.

The home was warm, comfortable and clean. People were satisfied with their bedrooms and living arrangements. Improvements to the home were ongoing. However, we found the new ground floor shower room was not fitted with a suitable lock or with a privacy screen; the registered manager told us this would be discussed with the maintenance person.

People told us they had no complaints about the service and felt confident they could raise any concerns with the staff or managers. One person said, “I have no complaints. It’s a first rate place; I can’t fault anything.” We found people’s concerns were not clearly recorded which made it difficult to determine whether appropriate action had been taken, whether there were recurring problems and whether the information had been used to improve the service. The registered manager told us she would review this.

There were systems to assess and monitor the quality of the service which would help identify any improvements needed. There were opportunities for people to express their views about the service with evidence their views had been listened to and used to improve the service.

Members of staff had a clear understanding of issues relating to consent and had received appropriate training. We saw that where possible people using the service or their relatives had signed the care plan to indicate their agreement with the care provided. People using the service told us they liked living at the home. One person said, “The staff couldn’t be any better, they go out of their way to help you.” The other person said, “It’s very nice here, the staff are excellent.”

We found the manager had implemented improvements to the system for monitoring the quality of the service. This involved regular auditing of the environment and most aspects of the care provided. There was evidence to demonstrate that people were consulted about the care and facilities provided at the home.

We observed staff asking people for their preferences and seeking consent before any action was taken. People were asked if they wanted any help or if they were happy with their food and drink choice at meal time.

People we spoke with felt they were supported by competent staff that were able to meet their needs. One person said, “The staff are very supportive, I had a few falls and lost a bit of confidence but they soon got me back on my feet again.”

The kitchen held a cardex file for everyone living in the home. Information held on the cardex file included type of diet needed, support aids required, consistency of food and any allergies.

Everybody we spoke with said there were enough staff. One person said, “I’ve been in a couple of homes and this is by far the best one. Staff are around all the time.” We observed all the staff taking time out to chat to people and share a joke.

The provider had a number of environmental and specific risk assessments including fire and undertaking a night duty. None of these risk assessments had been reviewed since 2010.

A programme of training had been implemented in order to ensure all members of staff were up to date with current practice. Members of staff were supported by the manager through regular supervision and appraisal meetings.

Arrangements were in place for obtaining the views of people using the service and their relatives about the care and facilities provided at the home.

People using the service told us they liked living at Victoria House and were satisfied with the care provided. One person said, “The carers are really caring.”

We found that improvements had been made since the inspection of 13 February 2012. These included involving people in planning and reviewing their care and more detailed care plans.

We noted that medicines were handled safely.

We found that a programme for staff training, annual appraisals and regular supervision by the manager was not in place. This put people at risk of receiving inappropriate and unsafe care.

An effective system for assessing and monitoring the quality of the service provided at the home had not been developed in order to ensure that people received safe and appropriate care.

During our visit time was spent speaking with people as well as observing interactions with the staff. We found overall this to be very positive. People were supported in a dignified and respectful manner, staff were patient, offering reassurance and encouragement where needed.

People spoken with told us; "They (the staff) are very kind", "The food is nice, you get a choice", "I can go to bed when I want",

"Yes, we do activities, I like the knitting and crafts" and " I've made some friends since

moving here".

We also spoke with a number of visitors to the home. They too were very positive about the staff and care provided. They told us; "It's a wonderful home", "The carers are wonderful", "They are so kind" and "We're always made welcome".

Interactions between people and staff were pleasant, eye contact was made, language

was kind and encouraging and people seemed to enjoy laughing and chatting with staff.

One visitor told us "My relative is in such good health, we can only put it down to the good care they receive".