This inspection took place on 03 and 11 January 2019. The first day was unannounced.

At the last inspection in October 2017 we found three key questions rated requires improvement. Since the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions to be rated ‘good’. At this inspection we found improvements had been made and the service was no longer rated requires improvement.

Victoria House 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. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide care and support for up to 41 people. At the time of our inspection 41 people were living at Victoria House Residential Home. The home has two floors, with bedrooms on both the ground and upper floor.

The service had 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.

The people who lived at Victoria House Residential Home told us they felt safe. There were enough staff to meet the needs of the people who currently lived there, and appropriate precautions were taken to ensure that staff had the right character to work with vulnerable people. However following employment ongoing security checks had not always been completed, we raised this with the registered manager to continue with some background checks on staff. The service used the local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding and were aware of their responsibilities to report any possible abuse.

The building was secure, clean and well maintained, and staff ensured any environmental hazards were minimised.

Care records were well kept and easy to follow. They gave a good indication of people’s abilities and provided a good description of their likes and dislikes. Where risk had been identified, risk plans were in place to minimise the risk of harm occurring. Senior staff were trained to administer medicines and we saw people were assisted to take their prescribed medicines in a way they were comfortable with by staff who understood their needs.

People were supported by a stable staff team who knew the people well. We saw that the staffing ratio reflected the needs of the people living at the service. The people we spoke with believed the staff were competent and knowledgeable. We saw from training records that all new starters received a thorough induction and ongoing refresher training to maintain their competence.

Staff communicated well with each other and we saw that information was exchanged between staff informally throughout the working day, and a handover meeting took place at the start and finish of every shift. This ensured that care staff were aware of any change in peoples’ needs and of any tasks which might need to be completed.

The registered manager and the care staff we spoke to, demonstrated a good understanding of capacity and consent. When people were being deprived of their liberty the correct processes had been followed to ensure that this was done within the current legislation.

People liked the food provided, and attention was paid to their dietary needs and preferences. Lunchtime was a sociable occasion and there was some conversation as people ate their meals.

Care staff monitored people’s general health, and where specific healthcare needs were identified the service liaised with healthcare professionals to provide an appropriate level of support.

We saw people were comfortable and well

This was an unannounced inspection carried out on 12 and 13 October 2017. Our last inspection took place on 15 and 20 February 2017 when the service was overall rated as 'Inadequate'. Four breaches of the regulations were found. At the last inspection we found the service was not always safely managed and there was sufficient numbers of staff to meet people’s needs. Environmental risks were not always well managed. People did not receive choice of food and drink and staff. Consent was not always recorded appropriately. The provider had not always submitted notifications to the CQC and audits had not identified the concerns we raised. We asked the provider to take action to make improvements.

Since that inspection this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection we found that improvements have been made and action taken. The service is no longer rated as inadequate overall or in any of the key questions and is now out of Special Measures.

Victoria House Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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 provider, Inniscastle Care Limited, is registered to provide accommodation for up to 41 persons who require personal care only in one adapted building. At the time of our inspection there were 28 people using the service.

There was 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.

We saw the service was clean and had appropriate infection control processes in place.

Each person we spoke with told us they felt safe. Relatives expressed no concerns about the safety of their family members and they were complimentary about the level of care provided. The service had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

We saw the service had systems in place for the safe administration and recording of medicines. We raised some small issues around medicines, their storage and recording. All people taking medicines had a medication administration record in place, which included a photograph to ensure medicines were given to the correct person. During the inspection most records we observed had been filled out correctly and all medicine amounts tallied.

All staff demonstrated a good knowledge and understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their best interest. We checked whether the service was working within the principles of the MCA. We found that the provider had followed the requirements in DoLS authorisations and related assessments and decisions had been appropriately taken.

Staff spoke positively about the training available. We saw all the staff had completed an induction programme and on-going training was provided to ensure skills and knowledge were up to date. However, records showed some staff had passed the provider’s recommended refresher timescales for some courses.

Staff confirmed they received supervision with their line manager, which along with the completion of team meetings, meant they were supported in their roles. Recor

This was an unannounced inspection carried out on 15 and 20 February 2017. Our last inspection took place on 25 November 2014 when the service was overall rated as ‘Good’. No breaches of the regulations were found.

Victoria House Residential Home is a care home without nursing. The care provider, Inniscastle Care Limited, is registered to provide accommodation for up to 41 persons who require personal care.

At the time of our inspection there was 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 registered provider did not use a tool to assess people’s dependency. We saw night staffing levels were not sufficient to meet people’s needs and the layout of the home meant staff were not always deployed in a way which met people’s needs.

Medicines were not safely managed as we saw a medication error had occurred in January 2017 when a member of staff not authorised to administer medicines was responsible for this. We saw gaps in the recording of medicine administration and found cream charts did not show people were receiving creams and lotions as prescribed. Staff medication competency checks had not been completed in the 12 months prior to our inspection for three staff members.

Risks were not appropriately managed as two upstairs windows in communal areas were found to be unrestricted. The registered provider took action to resolve this following our inspection. Weekly fire tests were last recorded as being carried out in December 2016. One person at risk of choking did not have a risk assessment for this and other risks to people had not always been identified.

Mealtimes were too close together which meant people did not have time to build an appetite for their next meal. Breakfast took place at 9:30 which was too late for some people who wanted this earlier. Biscuits were served before breakfast which meant there was no option before 9:30 for people who needed a soft diet. Food and drink was given to people without them being asked about their preferences at that time.

Care plans were not always fully completed and did not match other sections of people’s records as they had not been updated. Information which did not relate to people’s current needs was still in care plans. Monthly reviews were not always completed. Relatives had been invited to an annual review. Mental capacity was assessed as part of a pre-assessment. We saw documentation relating to consent was not always signed by the appropriate individual. Deprivation of Liberty Safeguards (DoLS) were not appropriately managed.

A programme of activities was in place, although this did not happen when the activities coordinator was absent as staff did not have time. A range of external entertainers visited the home to provide stimulation and regular trips out took place.

Confidential and sensitive information was not always securely stored as care plans were accessible to people and visitors.

Staff told us the registered manager was not approachable. The registered manager was based in a separate part of the building and managed the service remotely. Staff supervisions were not up-to-date and supervisions were based around competency questions. Training sessions were in place to address some gaps, although training in some areas which would be relevant to people’s needs was not provided.

People’s equality, diversity and human rights were not respected. Staff were in the process of arranging a religious service with a funeral provider. However, further checks during our inspection showed this person did not hold such religious beliefs.

The registered manager and deputy manager needed clearer insight into what is notifiable to the CQC. Quality mana

This was an unannounced inspection carried out on 25 November 2014. We last inspected the service in June 2013 and found they were meeting the Regulations we looked at.

Victoria House Residential Home is a care home in Leeds. The care provider Inniscastle Care Limited is registered to provide accommodation for up to 41 persons who require personal care, and those people who may have a dementia related condition. On the day of this inspection there were 36 people living in the home.

There is 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.

People told us they felt safe living in Victoria House. There were procedures to follow if staff had any concerns about the safety of people they supported. The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves.

There were sufficient staff with skills and competencies to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink.

People were able to develop friendships and join in activities. People were enthusiastic in describing a variety of activities that they could join in with. One person said, “We do all sorts – bingo, dominoes, we bake once a week. Some singers come in regularly, they’re good. We’ve been on trips. We do this music for health, although I’m not so keen on that.”

People told us that there was a friendly atmosphere and they regularly chatted with other people living at the home; One person told us that they had formed a friendship with another person living in the home. They said “We get on well. We like to sit together and we chat.”

People who lived at the home and visitors told us that they were not aware of any restrictions on times of visits or barriers to taking people out if they wished.

We looked at how the provider was improving the environment for people living with dementia. The home lacked signage so people with dementia would not easily find their way around the home. Contrasting colours and design of furnishings and carpets required improvements

We recommend that the service explores the relevant guidance on how to make environments used by people with dementia more ‘dementia friendly’

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they could access procedures to enable them to make complaints. One person told us that their bedroom was often cold during the night and had asked for a portable heater. This had been provided but had been taken away during the summer when it was warmer and had not been returned. The manager told us they would look into this concern.

People were encouraged to give their views about the quality of the care provided to help drive up standards. Quality monitoring systems were in place and the registered manager had overall responsibility to ensure lessons were learned and action was taken to continuously improve the service.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people.

We spoke with four people who lived in the home and one relative who was visiting. They were all very positive about their experience of Victoria House. Among their comments were:

“I can get up and go to bed when I want “

“The food is good, there is always a choice and I really like the tea time meal”

“The staff are good, they are all very approachable.”

We spoke with the manager, deputy manager, floor manager, a senior carer and a carer. All the staff we spoke with were knowledgeable about the people who lived in the home and their care needs. People’s individual needs and preferences were clearly stated in their care plan and staff demonstrated that they listened to and acted on people’s wishes.

People said they had no concerns during their time at Victoria House, but knew what to do if they did. All the people spoken with had positive comments about the home and how staff related to them

Throughout our visit we observed staff speaking to people about their care. On a number of occasions we saw staff explained to people what was about to happen and checked that people were in agreement with this. We observed staff asking people where they would like to sit in lounge areas. We saw staff spoke with people in a kind manner and were thoughtful and discreet when giving support to people.

We carried out this inspection together with a pharmacist inspector from the Care Quality Commission on 9 January 2013 to follow up on actions we asked the provider to act on at our last inspection on 9 October 2012.

We used a number of different methods to help us understand the experiences of people using the service including talking to people and observing the care provided. We spent time with people and we observed staff being friendly and warm towards people.

We spoke with four people who lived in the home and two relatives who were visiting. All the people spoken with were very positive about the care they received. One of the relatives was happy about the home and the support people receive. The other relative had some negative comments about the level of staff which they had spoken to the manager about.

We observed care staff treating people with dignity and respect. For example, they knocked on bedroom and bathroom doors before entry and when entering, discretely closed the door behind them to give people privacy.

We carried out this inspection together with a pharmacist inspector from the Care Quality Commission on 9 October 2012 to follow up on actions we asked the provider to act on at our last inspection on 13th June 2012.

We spoke to six people who live in the home and one relative who was visiting. All the people spoken with were complimentary about the care and support they received. One person said; “The staff are good to you,” whilst another commented “I like it here, we are well looked after.” People also spoke highly about the quality of food provided. One person said, “the food is good”

A visitor to the home told us they could visit at any time and were made to feel welcome. They also said that when they ask for something to be done it happens.

People living in the home were happy with the level of cleanliness throughout the home. One person said “They are always cleaning, its always lovely and clean”

People said they would talk to the deputy manager or the seniors if they had a problem.

We did not speak to people who use the service as part of this inspection.

People we spoke with said they were treated well. People who use the service described the staff as ‘kind’, ‘good girls’ and ‘very nice’.

People told us they were generally satisfied with the care they received. One person said, “They have been very good when I have been under the weather.” Another person said, “We’re very well looked after. Everything is alright.”

People told us they received good support from healthcare professionals and they can always see the doctor or a nurse if they are unwell.

Some people felt there were not enough activities or stimulation. One person said, “People are often sat in the lounge for long periods of time with only the TV for entertainment.”

We received feedback about staffing levels from people who use the service, visitors and staff. Some people told us there were sufficient staff; others said there were not enough staff. One person who uses the service said, “If I want the staff they are always there.” Another person who uses the service said, “Sometimes we have to wait to go to the toilet.”

Several people raised concerns about staffing levels. In the main, people told us there were enough staff to meet people’s basic needs although on occasions people sometimes had to wait for staff if they wanted assistance. Opportunities to spend quality time with people were very limited. One person told us that staff used to spend time chatting to people but this didn’t happen anymore. One member of staff said, “They get good care but it’s not a good quality of life. There’s no entertainment and that is what’s needed. There’s no outside area, they don’t go out. People need more 1-1 time.”