We inspected Victoria House on 26 June 2018. The inspection was unannounced. Victoria House 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 home is registered to accommodate up to 56 people in adapted four-storey premises, and 50 people were living there at the time of this inspection.

Our last inspection of the service was on 8 March 2016, when we found that the service was good in four areas but required improvement in the ‘effective’ domain. We found a breach of Regulation 11 of the Health and Social Care Act 2008: need for consent, because not all staff had received training about mental capacity and consent, and arrangements for the covert administration of medication were not compliant with the requirements of the Mental Capacity Act 2005. During this inspection we found a continued breach of Regulation 11.

We found a breach of Regulation 18 of the Health and Social Care Act 2006: staffing, because not all staff had completed the provider's comprehensive programme of training to ensure that they knew how to support people safely.

There was a breach of the Care Quality Commission (Registration) Regulations 2009: Regulation 18 because the provider had failed to notify CQC of occurrences at the home.

There was also a breach of Regulation 17 of the Health and Social Care Act 2006: good governance, because the provider did not have effective governance, including assurance and auditing systems or processes, to identify where improvements were needed.

The home is required to have 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 home had a registered manager who had been in post for several years.

The care files we looked at showed that people’s care and support needs were assessed covering their health and personal care needs and plans were written for the care and support people needed. These were kept up to date with monthly reviews. We found that the care plans lacked person-centred detail and some inappropriate language was used.

The home was clean and there were no unpleasant smells. Some improvements had been made to the environment since our last inspection. Maintenance records showed that regular checks of services and equipment were carried out by the home’s maintenance person and testing, servicing and maintenance of utilities and equipment was carried out as required by external contractors.

People had a choice of spacious sitting areas on the ground floor. These included a 'garden lounge', which was a quiet area with no television; a 'ballroom' where activities took place; a smokers' lounge; and a conservatory. People were free to walk around and choose where they wanted to spend their time.

Medicines were stored safely and people received their medication as prescribed by their doctor.

There were enough qualified and experienced staff to support people and meet their needs, and people we spoke with considered there were enough staff. Staff had received training about safeguarding vulnerable people from abuse.

Risk assessments were recorded in people’s care notes and plans put in place to reduce the risks identified. A log of accidents and incidents was maintained.

People told us they enjoyed their meals and had plenty to eat and drink.

People who lived at the home told us that the staff provided them with good care and support and we observed that staff treated people with kindness and respect. People we spoke with described the staff as kind and caring and we observed positive and respectf

We inspected Victoria House on 8 March 2016. The inspection was unannounced. Our last inspection of the service was on 11 June 2014, when we found that the service was compliant in all areas we looked at. The service is registered to provide accommodation with personal care for up to 56 people.

The home is required to have 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 home had a registered manager, however he was on holiday when we did the inspection.

During the inspection we found a breach of Regulation 11 of the Health and Social Care Act 2008: Need for consent. You can see what action we asked the provider to take at the end of this report.

During our visit we saw that there were enough staff to support people and meet their needs, and people we spoke with considered there were enough staff. People we spoke with described the staff as kind and caring and we observed positive and respectful interactions between staff and people who lived at the home. Staff had received training about safeguarding vulnerable people from abuse and about caring for people living with dementia.

The home was clean and there were no unpleasant smells. Some improvements had been made to the environment since our last inspection. Medicines were stored safely and people received their medication as prescribed by their doctor.

People were registered with local GP practices and the care plans we looked at gave details of people’s health needs. People’s needs were assessed before they moved into the home and referrals were made to medical professionals as needed. Care plans recorded the care and support people received.

People who lived at the home had a choice of spacious sitting areas on the ground floor. These included a 'garden lounge', which was a quiet area with no television; a 'ballroom' where activities took place; a smokers' lounge; and a conservatory. People were free to walk around and choose where they wanted to spend their time. People told us that they enjoyed the social activities provided and regular trips out.

People spoke highly of the home manager and staff considered that they worked well together as a team.

The focus of this inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

Records showed that people had home visits from health professionals including district nurse, community matron, chiropody, GP, dentist, dietician, and were supported to attend medical appointments. Some of the people who lived at the home had dementia and received support from community mental health services.

Risk assessments were recorded with regard to environment, nutrition, healthcare related conditions, manual handling and mobility and these were updated monthly by the manager.

An accident and incident log was in place and this enabled monitoring and identification of any recurrent events.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. Appropriate storage facilities were provided and medicines were handled only by senior staff who had received appropriate training.

There were enough qualified, skilled and experienced staff to meet people’s needs and all grades of staff were supported to extend their knowledge and skills.

Is the service effective?

We observed that people’s social needs were catered for and people told us:

“The activities are really good.”

“We have a dance sometimes.”

“We really enjoyed the trip yesterday.”

“I help in the hairdressers.”

The care staff we spoke with had a good knowledge of people’s individual care and support needs and they had all completed dementia awareness training.

During our visit we were able to speak with two professional visitors. One said that they had not visited the home much recently, but they considered that the service had improved and staff were more approachable. The other person told us “The home has improved. The staff are very helpful and the manager is on the ball.”

Is the service caring?

We observed care workers interacting with people in a positive and friendly manner and offering people choices, for example “Would you like to go through to the other room?”. People told us “They are good to you here.” and “They do look after you.”

A relative who had come to pick up a person who had been having a respite stay at the home told the manager that they were delighted with the care and hoped to use the service again in the future.

Is the service responsive?

People who lived at the home had a choice of spacious sitting areas on the ground floor. They were free to walk around choose where they wanted to spend their time. A variety of social activities took place every afternoon including two minibus trips out each week. One person we spoke with told us “I’ve got a mind of my own and I please myself what I do.”

The care plans showed that people's close relatives were consulted about their care and kept informed as appropriate. A section of the care plans was ‘My Life Story’ and this was completed using information from the person, if able, and from their family. A ‘Do Not Attempt Resuscitation’ form was included in one of the files we looked at and this had been signed by the person’s GP and by a close family member.

The care files contained assessments that had been completed before the person went to live at the home. Assessments had been carried out by a senior member of the home’s staff and there was also information from social services. These ensured that Victoria House would be the right home for the individual and their needs could be met.

The manager told us that three people at the home had Deprivation of Liberty Safeguards in place and full records were available to show the process that had been followed. An advocate was involved in the case of one of these people, and for another person, funding had been secured for a member of staff to accompany them on regular trips out.

Is the service well led?

During our visit we were able to speak with the service provider who is a medical practitioner. He told us that he visited the home at least weekly and had a good working relationship with the registered manager. The manager and the deputy manager held a management meeting every Monday. We saw that checking and monitoring processes were in place covering accidents, medicines, care plans, and environment. People we spoke with confirmed that they knew the manager and the home owner and were able to speak to them.

Both the manager and the deputy manager had achieved a national vocational qualification (NVQ) level 4 in management and had considerable experience in care work. Senior care staff had NVQ level 2 and/or level 3 and were working towards a team leadership qualification.

At our last inspection visit on the 16 April 2013 we found the premises did not protect the safety and wellbeing of people who used the service and people who worked in or visited the premises.

At this visit our tour of the building showed work was being carried out to improve the safety of the building and to improve the standard of décor and furnishings. We spoke with two people who used the service and two family members all told us they had The registered manager provided information and records that showed there was a maintenance programme in place that was regularly monitored.seen improvements in the décor and furnishings and facilities and were happy with the improvements that had been made.

We observed care workers supporting people in a supportive and caring manner. We spoke with five people who used the service who told us they felt cared for and listened to. Some comments made were:

"I am very happy living here and the staff are very kind and help me when I need it.”

“I have not been very well and the girls have looked after me so well, they call the doctor to come and check on me.”

We spoke with two family members who told us they were happy with the standard of care provided to their relatives.

We sought information from Wirral Department of Adult Social Services. They told us that they had seen improvements in how the service was managed and the care and support offered to people.

We looked at four care records that showed care and support was planned and delivered in a way that ensured people's safety and welfare. They also reflected their individual needs.

People told us they felt the management and staff team respected them and valued their right to make decisions for themselves. We also spoke with the relatives of two people who told us they would raise any concerns with the manager or deputy. Records held by the CQC showed the manager had responded appropriately to safeguarding concerns.

A tour of the building showed work had been carried out to improve the facilities and the environment for people, however further work was needed to ensure the environment and facilities were safe and met people’s needs.

We observed care workers and the management team engaging with people in a sensitive and caring manner.

We spoke with seven people who used the service. All said they felt cared for and respected by the staff team. Some comments made were:

“The girls are so good they really look after me well.”

The staff are very kind and check I’m ok this is my home and I like living here.”

We spoke with four family members. All said they were happy with the care and support offered to their relatives and felt involved in their care. They described the staff as caring and said they always appeared competent in their work. They felt there were good relationships between them their relatives and the staff team. Some comments made were;

“I find the staff, manager and deputy very approachable and I’m kept fully informed about my mum’s care.”

“I have no complaints about the care my relative gets I know they are very well looked after.”

People who used the service told us they were happy with the service they received and felt confident any concerns they raised would be dealt with.

We spoke with three healthcare professionals who told us they had observed care workers supporting people in a sensitive manner to maintain their privacy and dignity. They also told us they felt some areas of the home required maintenance and redecoration.

We sought information from Wirral Borough Council’s department of adult social services. They reported there had been issue identified to the service that required attention. These were being resolved by the manager and provider.

We spoke with five people who live in the home and nobody raised concerns about the way their medicines were handled.

We observed one care worker on two occasions not supporting people who used the service in a respectful and dignified manner. These incidents were discussed with the Manager who reported he would deal with them as a matter of urgency. We observed other care workers and ancillary staff offering respectful and sensitive support to people who used the service.

One family member told us they felt their relative did not receive much stimulus and was left to sit in front of the television all day. Four people who used the service told us they felt bored and would have liked more activities to do. The following comments were made by people who used the service and their family members;

“There is nothing to stimulate me.”

“The hairdresser comes each week, and the chiropodist comes every six weeks. We don’t really have activities, other than a game of bingo.”

“It is as if he has been abandoned. He is placed in a chair facing the television screen and that is his day.”

“I couldn’t be happier with the care and support given to mum we as a family are very happy with her living here.”

“I think there could be more for them to do in the day. But the staff are lovely and I have no concerns that dad is well cared for.”

At lunch time we observed one person who used the service ask another person if they were tired their response was “I am not tired, I am bored.”

The Manager acknowledged work needed to be done to ensure more activities were offered. He reported an activities co-ordinator had been appointed and would commence work once all employment checks had been completed.

People who used the service told us they felt safe living at Victoria House and would feel comfortable talking to the Manager if they had any concerns.

This inspection visit was carried out in response to concerns raised about the care and support offered to people who lived at the service. At the time of the visit we were informed by the Registered Provider that the Registered Manager and Deputy Manager had resigned. He acknowledged improvements were needed to ensure the service was safe and met the needs and expectations of the people who lived at Victoria House.

As part of our inspection visit we spent approximately two hours observing how people were supported in their daily lives. We observed limited verbal interaction between people who used the service and care workers.

There were no activities taking place people were sitting in the lounges watching the television. In one lounge people who used the service asked that the television be turned down as they could not hear each other speaking. In another lounge the television was turned on but the sound was turned down.

We spoke with people who used the service who told us the care workers were kind but very busy. Some comments made were;

“The girls are very good and work very hard.”

“They don’t spend much time in the lounges they are very busy.”

“There’s not much to do other than watch the telly I do get quite bored.”

We observed care workers wearing plastic aprons and gloves at all times whether they were supporting people with personal care or not.