This inspection took place on 5 September 2017. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

The service was last inspected in June 2016 and at that time required improvement. We found breaches of Regulations 17 good governance and regulation 18 staffing. This was because staff had not received supervision on a regular basis and best interest decisions were not recorded in care plans. Following our last inspection the provider sent us an action plan, which detailed the action they would take to make improvements at the home.

At this inspection we found that staff were now receiving regular supervision and best interest decisions were fully documented in care plans.

Victoria House Care Centre is a purpose built care home providing personal and nursing care to older people and older people living with a dementia. It is located close to the centre of Stockton-On-Tees, within easy reach of local amenities.

There was a registered manager in place who had been registered with the Care Quality Commission since 2015. 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.

Risks to people arising from their health and support needs and the premises were assessed, and plans were in place to minimise them. Risk assessments were regularly reviewed to ensure they met people’s current needs. A number of checks were carried out around the service to ensure that the premises and equipment were safe to use.

There were enough staff to meet people's needs. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. Staff were now given effective supervision and a yearly appraisal.

Staff understood safeguarding issues and were aware of the whistleblowing policy [telling someone] if they had concerns.

Staff received training to ensure that they could appropriately support people, and the service used the Care Certificate as the framework for its training. Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) training and clearly understood the requirements of the Act. Best interest decisions were made appropriately with the person and family fully involved. This meant they were working within the law to support people who may have lacked capacity to make their own decisions. The manager understood their responsibilities in relation to DoLS.

People were supported to maintain a healthy diet, and people’s dietary needs and preferences were catered for. People told us they had a choice of food and everyone enjoyed what was on offer. Where people had a percutaneous endoscopic gastrostomy (PEG) in place and was nil by mouth. A PEG is a procedure to place a feeding tube through the skin and into the stomach to give the nutrients and fluids needed. Along with advice from the dietician and SALT team the service was offering taste spoons or oral food tasters. An oral food taster or taste spoon is where an empty spoon is dipped in custard or yogurt for example; all the excess is allowed to fall off the spoon leaving a very thin covering.

We saw evidence in care plans to show the service worked with external healthcare professionals to maintain people’s health.

We found the interactions between people and staff were kind and respectful and people were offered choice throughout the day.

Procedures were in place to support people to access advocacy services should the need arise. At the time of inspection no one was using an advocate.

Complaints were acted on using the guidance of the services complaints policy.

Staff had a clear understanding of people's needs and how they liked to be sup

We inspected Victoria House Nursing Home on 15 June 2016. This was an unannounced inspection which meant that the staff and registered provider did not know that we would be visiting.

Victoria House Nursing Home provides care and accommodation for up to 70 older people and / or older people living with a dementia. The home is purpose built and located close to the centre of Stockton–on-Tees and within easy reach of local amenities. At the time of our inspection visit there were 49 people who used the service.

The home had a registered manager in place. 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 always consistently received supervisions but the registered manager was working on improving this. Records showed that few supervisions had been carried out in 2015. A total of 16 supervisions had been carried out so far in 2016 (there were 73 staff employed and this included the registered manager). Records of supervisions carried out by registered manager confirmed that staff were invited to have an open discussion about their roles and responsibilities and any improvements they had for the service. Staff appraisals were up to date.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty were being met. At the time of the inspection 15 people were subject to DoLS authorisations. People subject to DoLS had this clearly recorded in their care records and the registered manager kept a chart of when authorisations were due to expire. This meant further applications could be made in a timely way if necessary, which helped to protect people’s rights. However, where people lacked capacity best interest decisions made on their behalf were not always recorded within the plan of care. Our judgment was that staff did act in the best interest of the people they supported but that processes had not been followed to formally assess and record this.

Systems were in place for the management of medicines so that people received their medicines safely. However, the temperature of rooms in which medicines were stored were not always recorded and the clinic room on occasions was too warm at 26 degrees Celsius. If medicines are not stored at the correct temperature they can become less effective.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed and nutritionally screened. The service used the Malnutrition Universal Screening Tool (MUST) to assess people. This is an objective screening tool to identify adults who are at risk of being malnourished. As part of this screening people should be weighed at regular intervals and depending on the risk appropriate Records looked at during the inspection identified that staff were incorrectly calculating the risk when people lost weight. This meant that staff might not take the appropriate action needed. The registered manager acknowledged that improvement was needed for the monitoring of people’s weights and that staff required training. They told us after the inspection they had contacted the learning and development team to request urgent training for the MUST tool.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed, however this was not always on a monthly basis which was in accordance with the registered providers policy. Risk assessments covered areas such

During the visit, we spoke with 11 people who used the service. The people we spoke with told us that they were pleased with the service and felt that the service being provided was excellent. People told us, “This is a wonderful home and the staff treat you like family”, “The staff treat me very well and are really caring”, and “I find that the home is well-run.”

In the dementia care units people experienced difficulty communicating their views so we observed the staff practices. From our observations we found that care staff worked in ways that supported the people and treated individuals with a great deal of humanity as well as empathy.

The manager Lesley Jones has recently taken up post in another of the provider’s home and a new manager came into post two weeks prior to our visit. The staff consistently included people in conversations and lots of friendly banter went on throughout our visit.

We found people's needs were assessed and care was planned in line with their needs.

We found that the staff had access to a wide range of training and the provider ensured that mandatory training was regularly refreshed.

An effective system was in place to ensure the on-going quality of the service was maintained.

We spoke with two people who lived at Victoria House Care Centre and had informal discussions with others throughout the day. We also spoke with six relatives, the manager, deputy manager and five staff. Some of the people living at the home were unable to verbally communicate their views and experiences to us. Throughout the inspection we observed people being treated kindly and with respect. We saw recorded evidence that people and/or their relatives had been consulted about their care and support. One person said, "The staff are very family orientated, they show respect and courtesy. I am well looked after and involved in decisions about my care." "I am quite free to do anything I like."

We saw that people had their needs assessed and a range of care plans were in place, which gave the staff the information they needed to meet people's needs in a safe and planned way. We spoke with the family of one person who had lived at the home for a number of years. They said, "We feel he/she is safe and is cared for in a lovely way." "The staff are brilliant, we have confidence in their knowledge and skills to meet his/her needs." "We can now miss a couple of days without visiting and have confidence."

We saw that the service had good systems in place for recruiting and inducting new staff. We also saw that there were appropriate systems in place in the event that people needed to raise concerns or make a complaint.