Victoria House is a residential care service providing support and accommodation to people with a learning disability, and other associated conditions such as Autism. The service is registered to support a maximum of eleven people. At the time of the inspection 8 people were living at the service.

Victoria House 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 accommodation is provided within two separate properties situated next door to each other. One of the properties is named Victoria House and the other Grenville House. The service is registered as one service under the name of Victoria House. Staff worked with in both houses and although people have their own bedroom and facilities provided either within Victoria or Grenville they were able to spend time in both houses if they chose to do so. For the purpose of this report we will refer to all parts of the service as Victoria House.

At the last inspection on the 22 and 29 September 2015 the service was rated as Good.

At this inspection we found the service remained Good.

Why the service continues to be rated as Good.

People were safe living at the home and with the staff supporting them. We saw people were happy and trusted the staff. There were systems and processes in place to minimise risks to people. These included a robust recruitment process and making sure staff knew how to recognise and report abuse. There were adequate numbers of staff available to meet people’s needs in a timely manner.

People received effective care from staff who knew them well and had the skills and knowledge to meet their needs. Staff monitored people’s health and well-being and made sure they had access to healthcare professionals according to their individual needs.

People had their medicines managed safely, and received their medicines in a way they chose and preferred. Staff undertook regular training and understood the importance of safe administration of medicines. Staff said they undertook regular competency checks to test their knowledge and to help ensure their skills were up to date and in line with best practice.

People were supported to have maximum choice over their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by staff who were kind and caring. Where people were distressed or found it difficult to express themselves staff showed patience and understanding. People’s privacy and dignity was promoted and respected.

The service was responsive to people’s needs and people were able to make choices about their daily routines and how support was delivered. People had access to a range of organised and informal activities. Relatives were welcomed in the home and their views and feedback were taken into account when planning care. Information was provided in an accessible format for people in all areas. This meant they could have full control of their care and daily life.

Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The registered manager and provider treated complaints as an opportunity to learn and improve.

The home was well led by an experienced registered manager and management team. The provider had systems in place to monitor the quality of the service, seek people’s views and make on-going improvements.

Further information is in the detailed findings below.

There were ten people living at the service on the day of our visit. Six of these lived at Victoria House and four lived next door at Grenville House. We met with all of the people at some point during our visit and had meaningful conversations with three of them. Some people were unable to fully express their views and throughout the day we observed these people.

We spoke with three relatives, six members of staff, the registered manager and the locality manager.

The home had a homely and welcoming atmosphere. Throughout our visit we saw that people who lived at the home appeared comfortable and at ease with the staff who supported them. People told us they liked living there "I am happy" and "I like it here".

Staff knew each person's needs well and demonstrated how well they were supported. Relative comments included "all members of staff go out or their way to meet X's needs".

Each person had a plan of care that contained all the information required. Relatives were happy with the care provided and comments included "satisfied with all the care" and "happy with the care given to X by all the team". Staff sought specialist advice when necessary.

People had a range of activities, hobbies and interests which was based on their individual choices and abilities.

We saw that people chose their own meals and had a menu that was varied and nutritious.

Staff underwent a thorough recruitment procedure, felt supported and enjoyed their work.

People using the service had a high level of care needs. This meant that it was difficult for some people to tell us what they thought of the home and the care they received.

Three people who were able to speak to us said, “Victoria House is lovely” “I like living at Victoria house, I like cooking and going to a cooking group” “My key-worker supports me well”

During our visit we saw that staff treated people respectfully at all times, promoting choice and independence whenever possible.

The management and staff were aware of people’s rights and we saw examples of when meetings had taken place to ensure that decisions were being made in people’s best interest.

We found that people engage in a range of activities inside and outside the home. On the day of our visit one person was doing some baking and two other people went with staff to a community dance group. The service had systems in place to review people’s social activities to ensure that they were appropriate and what people wanted and enjoyed.

The staff we spoke to were able to tell us about different types of abuse, and what they needed to do to keep people safe.

The provider regularly reviewed the quality of the service and was able to demonstrate that changes had been made as a result of any feedback.

The inspection took place on the 22 & 29 September 2015 and was unannounced.

Victoria House provides care and accommodation for up to 11 people. The accommodation is provided within two separate properties situated next door to each other. One of the properties is named Victoria House and the other Grenville House. The service is registered as one service under the name of Victoria House. Staff worked within both houses and although people have their accommodation provided either within Victoria or Grenville they were able to spend time in both houses if they chose to do so.

Victoria and Grenville House support people with a learning disability and associated conditions such as autism. At the time of the inspection 10 people were living at the service. Six people at Victoria House and four people at Grenville House.

The service had 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.

At the time of the inspection the manager had been dealing with the outcome of a number of difficult incidents within the home. During a 12 month period people and staff had been affected by the health and behaviours of a person who had since left the service. CQC had been kept well informed of this situation and the manager and senior staff within the organisation had worked hard to ensure the safety and well- being of all concerned.

We spent time with people seeing how they spent their day and observing the care and support being provided. Some people were able to talk to us, but most people had limited verbal communication. People were treated with care and respect by the staff team. We observed people laughing and smiling and having friendly conversations with each other and the staff supporting them. Relatives said, “, When we visit our relative always appears happy, comfortable and safe” and , “ When we take […] out they are always keen to get back, I think that is a sign that they feel safe and secure in the home”.

Recruitment practices helped ensure staff working in the home were fit and appropriate to work with vulnerable people. Staff had received training in how to recognise and report abuse, and all were confident any concerns would be taken seriously by the manager and organisation.

There were sufficient numbers of suitably qualified staff to keep people safe. Staff recognised people’s rights to make choices and to take everyday risks. Feedback from an independent advocate included, “The staff are good at allowing people to make choices and take risks. They think about the possible risks and how to keep people safe, but also remember they are adults and have rights”.

People had their medicines managed safely, and received their medicines on time and in a way they chose and preferred. People’s health and well-being was considered important and systems were in place so staff could recognise changes in people’s health and take prompt action when required.

People where appropriate were assessed in line with the Deprivation of Liberty Safeguards (DoLS) as set out in the Mental Capacity Act 2005 (MCA). DoLS provide legal protection for vulnerable people who are, or may become deprived of their liberty. The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals when appropriate.

Staff demonstrated a good understanding of the main principles of the Mental Capacity Act (MCA).

We saw people were supported to make everyday decisions for themselves such as what time they got up, when they had their meals and how they occupied their time. One person had chosen to have a lie in and then came down later for their breakfast. Another person was being supported by staff to make a choice about where they wanted to go for lunch and an afternoon walk. Each person’s support plan stated, ‘Staff must assume […] has capacity unless proven otherwise’.

People’s support plans included clear and detailed information about their health and social care needs. Information about people’s needs were regularly discussed and updated so that staff had accurate information when providing care. We saw that when necessary information had been amended to reflect sudden changes in people’s support needs. For example, one person required additional assistance with personal care needs following an injury and admission to hospital. Staff were fully aware of the new guidelines, the role of other agencies, and the plan to support the person to regain their independence.

The registered manager took an active role within the home. There were clear lines of accountability and responsibility within the management structure and tasks were delegated to help ensure the smooth and efficient running of the service. The manager had a clear vision for the service, and acted promptly when the need for improvement had been identified.

There were effective quality assurance systems in place to monitor the standards of the care provided. Learning from incidents, feedback and complaints had been used to help drive improvement across the service.