Archived: Victoria Cottage Residential Home

Updated 12 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service and to provide a rating for the service under the Care Act 2014.

Before our inspection, we reviewed information we held about the service. This included information received from local health and social care organisations and statutory notifications. A notification is information about important events, which the provider is required to send us by law, such as, allegations of abuse and serious injuries. We also contacted commissioners of the service and asked them for their views. We used this information to help us to plan the inspection.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

One inspector and an inspection assistant undertook the inspection. During our inspection visit, we spoke with two people who lived at the home and five relatives. We also spoke with two members of care staff, a member of the catering team, the team leader, the manager and a project manager. In addition, during the course of our inspection we spoke with three external health and social care professionals.

To help us assess how people's care needs were being met we reviewed all, or part of, six people's care records and other information, for example their risk assessments. We also looked at the medicines records of four people, four staff recruitment files, training records and a range of records relating to the running of the service. We carried out general observations of care and support and looked at the interactions between staff and people who used the service.

We asked the manager to send us a copy of various policies and procedures and we received this prior to this report being completed.

Updated 12 October 2018

We conducted an unannounced inspection at Victoria Cottage on 24 May 2018. Victoria Cottage 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. Victoria Cottage accommodates up to 18 people in one building. On the day of our inspection, nine people were living at the home; all of these were older people, some of whom were living with dementia.

This service is also registered as a domiciliary care agency. This means it can provide personal care to people living in their own homes. At the time of our inspection, no one was being supported in their own home.

At the last inspection in May 2017, we asked the provider to take action to make improvements to risk management, in particular risks associated with falls. During this inspection, we found that although the management of falls risk had improved, risk management in other areas had deteriorated. We also identified concerns in relation to safeguarding people from abuse, staff training and competency and governance and leadership. We found five breaches of the Health and Social Care Act 2008 regulations. You can see what action we told the provider to take at the back of the full version of the report.

There was no registered manager in post at the time of our inspection. The previous registered manager had left the home in January 2018. 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. There was a service manager in post who told us they were planning to register. We will monitor this.

During our inspection we found the service was not safe. People were not always protected from risks associated with their care and support. People were placed at risk of choking as risks were not assessed and staff did not have access to guidance to inform their care and support. Moving and handling risk assessments had not been updated to reflect changes in people’s needs, which meant staff did not have the most up to date information about how to safely support people. People were subject to unsafe and restrictive interventions as staff were not provided with information about how to manage behaviours resulting from anxiety and distress. Serious incidents were not investigated; this meant action had not been taken to reduce the risk of reoccurrence.

People were not protected from abuse and improper treatment. We found evidence of a number of incidents that had not been referred to the local authority safeguarding adults team for investigation. The cause of unexplained marks to people’s skin were not investigated. Infection control and prevention measures were not effective, this exposed people to the risk of infection spreading. People could not be assured that good hygiene practices were followed, effective cleaning procedures were not in place for some items of equipment and some areas of the home.

There were enough staff to meet people’s needs and ensure their safety. Safe recruitment practices were in place to reduce the risk of people being supported by unsuitable staff. Overall, medicines were stored and managed safely. However, medicines errors were not always identified and investigated, and topical creams were not always administered as required.

People were supported by staff who did not always have appropriate training or support. Temporary agency staff did not have training in key areas and when staff moved into new roles within the home they were not given additional training to support them to fulfil their duties.

Systems to protect people from risks associated with eating and drinking were not always effective. We received mixed feedback about the food. Records did not consistently demonstrate people had been provided with enough to drink. Staff did not always have sufficient information to promote good nutritional intake and people’s dementia related needs had not been considered at mealtimes.

People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice. People had access to healthcare and their health needs were monitored and responded to. There were systems in place to ensure information was shared across services when people moved between them. The design and decoration of the building accommodated people’s diverse needs.

People did not consistently receive caring support. Permanent staff were kind and caring, had an understanding of what was important to people and how to communicate with them. However, people told us temporary agency staff did not always treat them in a respectful and dignified manner. The language used by staff to describe people did not always promote their dignity.

People were supported to be as independent as possible. People were involved in day-to-day choices and decisions and in planning their care and support. People had access to advocacy services if they required this to help them express their views. People’s right to privacy was respected.

People were at risk of receiving inconsistent support as care plans did not all contain accurate, up to date information. Care records did not evidence that people received the care they required to meet their needs. People were provided with opportunities for social and recreational activity.

People’s friends and family were welcomed into the home and were involved in the care and support of their loved ones. People were provided with an opportunity to discuss their end of life wishes and this was compassionately recorded in people’s care plans. There were systems to investigate and respond to concerns and complaints; however these systems were not always followed which meant the provider could not assure us complaints had been handled properly.

Since our last inspection there had been a deterioration of the quality, safety and leadership of the service. Improvements noted at our last inspection had not been sustained and consequently people were placed at risk of harm. Systems to monitor and improve quality and safety were not consistently effective in identifying and addressing areas for improvement. Improvements had not always been made, or sustained, in response to known issues. Records of care and support were not accurate or up to date and staff did not always have access to clear information about the people they were supporting. In addition, audits of care plans were not effective. Sensitive personal information was not stored securely. Staff and people living at the home were able to express their views in relation to how the service was run.