The inspection took place on 18 and 23 May 2018 and was unannounced.

Victoria Lodge is a residential care home registered to provide accommodation and care for up to 23 people, the majority of whom have a diagnosis of dementia and/or other care needs. At the time of our inspection, 21 people were living at the home. Communal areas include a sitting room, dining room/conservatory and access to a rear garden. Accommodation is over three floors and is serviced by a lift. Victoria Lodge 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 care provided and both were looked at during this inspection.

A registered manager was 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.

Following the last inspection, the service was rated as 'Good' overall, with 'Requires Improvement' under 'Effective'. At the last inspection in May 2016, we asked the provider to take action to make improvements in relation to staff training, supervision and appraisal. Improvements had been made in these three areas and the service remains rated 'good' overall.

Notifications that the provider was required to send to us by law had not been done in relation to Deprivation of Liberty Safeguards authorisations. Records such as Medication Administration Records (MAR) had not always been completed accurately. Information relating to prescribed medicines on MARs had been hand-written by a member of staff, but had not been checked by another member of staff in line with the service's quality assurance process or National Institute for Clinical Excellence guidelines. The services quality assurance processes had not picked these omissions up and therefore is an area that requires improvement.

Some information was provided in an accessible format and the registered manager informed us this was work in progress. Activities were organised for people.

Staffing levels were consistent, Staff commented on how busy it could be at certain times of the day.

Staff knew how to keep people safe and had completed training in safeguarding adults at risk. A range of risk assessments had been completed in relation to people and premises. New staff were recruited safely. The home was clean and tidy and staff had completed training in infection control.

Staff completed a range of mandatory training and were encouraged to study for vocational qualifications. Menus for people were planned in line with their dietary needs, likes and dislikes. Drinks were freely available. People received support from a variety of healthcare professionals. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People were looked after by kind and caring staff who knew them well. As much as they were able, people were involved in day-to-day decisions and choices. Staff were reassuring and friendly with people and treated them with dignity and respect.

Care plans were detailed and written in a person-centred way. Activities were organised for people and there were plans to employ an activities co-ordinator. Complaints were managed in line with the provider’s policy.

Staff were involved in the development of the service and their feedback obtained through staff meetings. Employee satisfaction surveys had been completed by staff to gain their views about working at the home. Compliments from relatives were received and recorded. Residents’ meetings took place and people were asked for their views and suggestions about the

The inspection took place on 17 and 19 May 2016 and was unannounced.

Victoria Lodge is registered to provide care for up to 23 people older people who are living with dementia. At the time of our inspection, 17 people were living at the home. Victoria Lodge is situated close to the town centre of Worthing and within walking distance of the seafront. Accommodation is provided over three floors and all rooms are of single occupancy; some have en-suite facilities. There is a large sitting room and adjacent conservatory, the latter also used as a dining area. People have access to an attractive rear garden with seating areas.

A registered manager was 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.

Staff had not received specific training on the requirements of the Mental Capacity Act 2005 and did not understand their responsibilities under this legislation. Some staff had not completed or updated their training in all essential areas. Staff had supervision meetings, but formal meetings or annual appraisals were not planned on a regular basis.

Staff understood how to gain people’s consent before delivering their care and involved people in day-today decisions. Coded keypads around the home prevented people from leaving the building or accessing some parts of the home without staff support, which was for their safety. People had sufficient to eat and drink and were encouraged to maintain a balanced diet. They had access to a range of healthcare services and professionals. The home was undergoing refurbishment.

People and their relatives felt the home was a safe place. Staff understood how to protect people from the risk of abuse and knew what action to take if they suspected abuse was happening. People’s risks had been identified and assessed and were managed appropriately. There were sufficient numbers of staff on duty to keep people safe and meet their needs. Safe recruitment practices were followed. The home was clean and there were no unpleasant odours.

People were looked after by kind and caring staff who knew them well. People were encouraged to be involved in all aspects of their care and they were treated with dignity and respect.

Care plans were person-centred and provided detailed information and guidance to staff about people’s care needs, including their personal histories, likes and dislikes. A range of activities were available to people and the provider was planning to increase the number of organised activities delivered by an external activities co-ordinator. Complaints were managed appropriately in line with the provider’s policy.

People were asked for their views about the service and the registered manager had individual meetings with people to obtain their feedback. Staff felt supported by the management team and the registered manager spoke highly of the provider. A range of audit systems was in place to monitor the quality of care delivered and the service overall.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the back of this report.

Victoria Lodge is registered to provide nursing or personal care to 23 people. At the time of our visit there were 16 people living at this location.

Our inspection team comprised two adult social care inspectors. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with five people who used the service, one person visiting a friend, four staff supporting them and from looking at records.

If you want to see the evidence supporting our summary, please read the full report.

Is the service safe?

We saw that care and treatment was planned and delivered in a way that ensured risks were appropriately assessed and support provided to mitigate risks. One person told us, “Yes, I feel safe”.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We were told that no applications have needed to be submitted, but the manager, who had recently come into post, was in the process of reassessing people to ensure that appropriate arrangements were in place.

Recent improvements to the premises meant that people were cared for in a suitable environment. For example, the call system was being upgraded so that staff would know on the ground floor if people needed assistance on the top floor. We saw that suitable fire evacuation procedures were in place and that fire equipment was fit for purpose.

Staff had received training which enabled them to look after people safely.

Is the service effective?

People told us that they were happy with the care that had been delivered and that their needs had been met. One person said that staff checked with them, “Would you like to dress now. It’s very optional”. We saw that people were consulted about their care and treatment and that, where possible, their relatives had also been involved. Relatives had, in some cases, provided life histories of people so that staff were able to chat with them about things that were personal to them.

There was a choice of food available to people on a daily basis and where people required special diets, we saw these were catered for.

Is the service caring?

People had a keyworker who was the link between that person, any visitors and health professionals. A member of staff told us that, “Everyone gets involved”. People we spoke with felt cared for. One person described how they had been able to go out and said, “Staff take me out for a walk in the chair. We went out at 1.30 pm and didn’t get back until 5.00 pm. We were searching for hats, so we can go out and sit in the garden. It was very nice”.

We heard one person reminiscing about the war with a member of staff who was keen to hear about an air raid shelter built in their garden.

Is the service responsive?

We saw that there was a range of activities available to people who used the service. One person said, “We have special classes and activities” and another conformed that there were all sorts of different activities on offer.

During the lunch period, we saw that a person did not like the food on offer and that they were offered an alternative of a cheese omelette, which they accepted.

We saw that advice was sought from other health professionals when required, for example, when one person had suffered a loss in weight and needed a change of diet. The catering arrangements for this person had been changed to accommodate their changed needs.

Is the service well led?

The staff we spoke with were clear about their roles and responsibilities and had opportunities to obtain further qualifications if they wished. Staff views were sought through regular supervisions and yearly appraisals. Staff we spoke with said they felt supported by management and were asked at supervision, “Do you feel valued?”. Another member of staff told us that they were consulted about any improvements that they wanted to suggest and said the management were, “Very supportive, everything you ask for they try to get”.

We saw that there were effective systems in place to regularly assess and monitor the quality of service that people received.

We carried out this inspection in response to recent safeguarding concerns received about the service. During our inspection we spoke with the manager, four members of staff and four people who used the service. People made positive comments about the service. These included "It's excellent here", "I'm quite happy" and "Very nice".

We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. There were detailed care and support plans in place for people who used the service. Staff supported people as individuals and at an appropriate pace. Risks had been identified although the recording of incidents and accidents was not easy to understand.

At the time of this inspection the service did not have a registered manager.

We looked at medicine management systems. We found that much improvement had been implemented since our last visit in December 2013. People received their medicines as prescribed and intended by their doctor.

At our last inspection on 22 November 2013 we found that the provider was non-compliant with regard to ensuring people received safe and appropriate care that met their individual needs. We assessed that this had a major impact on people who used the service. We asked the provider to become compliant by 6 January 2014.

During this inspection we looked at the care records of three people. We spoke with the provider and four staff members.

We saw evidence that people’s individual needs had been assessed and that care was planned in order to meet these needs. The staff we spoke with were able to demonstrate they understood the care needs of the people who lived at the home. We also saw that risk assessments and care plans were reviewed to reflect people’s current needs. This meant that arrangements were in place to ensure people experienced safe and appropriate care.

There was no registered manager in post at the time of this inspection.

We undertook this inspection following receipt of information of concern in relation to the safe management of people's medicines.

We spoke with two staff members and reviewed the medication records of all the people who lived at the home. We found evidence that medicines were not always administered in a safe and consistent way. We also found that appropriate arrangements for the recording of medicines administered were not in place. The provider did not have accurate records of the stock of controlled and there were no audits undertaken of medicines management. This meant that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

At the time of this inspection the provider did not have a registered manager in post.

We spoke with three people who used the service. We also spoke with three relatives who visited the home on the day of our inspection. They told us that they were happy with the home and that the staff were very caring and kind. One person said. "The girls (the care workers) are very kind ... they are very good to me."

We spoke with six members of staff. They told us they liked working at the home. One described it as "Really homely." and, "More of a home than a care home." They said they felt well supported in their roles but had not received any regular formal supervision. The training records we looked at showed that not all staff had up to date mandatory training.

We looked at the care records of five people. We found evidence to show that the planning and delivery of care did not always meet people's individual needs or ensured their safety and welfare. This meant people did not always receive effective, safe and appropriate care. We also found that people were not provided a choice of suitable and nutritious food and that they were not always protected from the risks of inadequate nutrition.

The provider did not have arrangements in place to monitor the quality of service that people received. Risks to the health, safety and welfare of people who used the service were not monitored or managed.

We inspected the service on 22 August 2012 and found that risks to people were not adequately assessed or planned for. We also inspected the service on 24 October 2012 and found that medications were not properly secured or recorded. The provider wrote to us and told us they had implemented several changes to address these concerns. We visited the service to ensure they had made the necessary changes.

We spoke with four people who used the service. People told us that staff supported them to a high standard and their needs were met.

We found the home had appropriately assessed people's needs and potential risks. We found that people were protected from the risk of inappropriate care.

We found that people's prescription medications were stored securely and a record of medication administration was maintained. People were well supported with their medications.

People’s feedback did not relate to the outcome we inspected. Instead, we relied on our observations and discussions with the manager and staff to form our judgement. We observed medicines being given to people. We saw that medicines were given to people safely. We were told that policies and procedures were generic and this was the next thing to be addressed by the manager. We found some concerning practices in relation to the recording of medicines.

People’s feedback did not directly relate to the outcome we reviewed on this inspection. Instead, we relied on our review of employee documents and our discussion with the new manager to form our judgement.

We found that the provider had recruitment and vetting procedures in place to ensure people were supported by staff who were adequately skilled and had necessary checks.

We spoke with four of the 15 people living in the home. People told us that they liked living there and were happy with the quality of care. People said they felt safe, involved, and treated kindly by staff. One person said, “they [the staff] are very good to you.” Another person said, “I’m very happy here.” Another person told us, “the atmosphere here is lovely.”

We spoke with four of the 16 people who lived at Victoria Lodge Care Home. They told us they were very happy with the care afforded to them. One person told us, “I wouldn’t want to go anywhere else!” Another person said, “I have no complaints. I am well looked after.”

We spoke with three members of care staff who were on duty. They demonstrated they knew about the level of care that each person required.

We also spoke with the manager who informed us they had taken up their post three weeks ago. They also informed us they had found it necessary to recruit new care staff during this period. This was due to several care staff choosing to leave at the same time as the previous manager left.