The Queensmead Residential Care Home

The service is purpose built and provides accommodation and facilities over three floors. The needs of people varied, some people were mainly independent, some had low physical and health needs and others had dementia and memory loss. The service provided respite care for people wanting short stays in a care home.

People’s experience of using this service and what we found

Quality systems had not been fully established and imbedded into daily practice to support quality care and record keeping in all areas. Some records were not complete or accurate this included care records. They did not support or record the care and support provided. The lack of accurate and contemporaneous records was identified as an area that needed improvement.

Staffing arrangements were safe and ensured people’s needs were met in a timely way. Staff had received training and regular updates on safeguarding people. They understood how to respond to any suspicion or allegation of abuse or discrimination. Staff were recruited safely. People's medicines were handled safely. There were suitable arrangements in place to assess and respond to any risk to people. The service was clean and there was a plan to redecorate and maintain the building.

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

People received personalised care that was delivered by staff who had a good understanding of their needs and how they should be met. People had access to health professionals to promote their health and social well-being.

There was a commitment to staff training and development. Staff received a varied training programme that ensured they had suitable skills to care for people. Staff were supported and had the opportunity to develop new skills. People's dietary needs were assessed and known by staff. The food provided met people’s needs and preferences.

People and their relatives were treated with kindness and compassion. People were encouraged and supported to maintain their independence. People’s privacy and dignity was protected, and people said they were ‘well looked after’. One relative told us, “I would come here, I know they would look after me.”

Complaints were listened to and resolved in a timely way with people satisfied with outcomes. People had choice and control over the activities they wanted to participate in each day. Staff ensured people were not isolated even if they liked to spend time in their room.

The registered manager knew people and staff well and promoted an open culture where people and staff felt they could share their views. They understood their responsibilities and were passionate and committed to delivering a high standard of care to each individual person in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 10 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If we receive any concerning information we may inspect sooner.

The service had a registered manager in place. 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.

This inspection took place on 27 April 2017 and was unannounced.

Management systems that included quality monitoring did not always ensure safe and best practice in all areas. Documentation was not always up to date and accurate. Staff records were not always complete a recruitment file did not include confirmation of identity and action taken following a complaint raised about a staff member had not been clearly recorded.

People were looked after by staff who knew and understood their individual needs well. Staff treated people with kindness and compassion and supported them to maintain their independence. People’s dignity was protected and staff were respectful. All feedback received from people and their relatives was positive about the care, the atmosphere in the service, and the approach of the staff. One relative told us “Staff really do go over and above what you could expect from them they are so good.” Visiting professionals were positive about the care and support provided. They told us staff worked with them to improve people’s health. Both relatives and visiting professionals told us they would recommend the service and consider it for themselves or other relatives in the future.

People told us they felt they were safe and well cared for at The Queensmead Residential Care Home. People were protected from the risk of abuse because staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff had been trained on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered manager had an understanding of both and followed correct procedures to protect people’s rights. People’s Medicines were stored, administered and disposed of safely by staff who were suitably trained. People had the opportunity to take part in a variety of activities in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported to maintain their own friendships and relationships.

Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in a care home. Staff were provided with an induction and training programme to support them to meet the needs of people. People’s care needs were identified and responded to with external health care professionals involved with care and treatment appropriately when needed.

There was a variety of activities and opportunity’s for interaction both in and outside of the service. This took account of people’s preferences and choice and gave people meaningful interaction and activity. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships. The environment was clean and a programme of improvement was being progressed. People’s rooms were individual, staff respected each room as people’s own space.

People were complementary about the food and the choices available. Staff monitored people’s nutritional needs and responded to them. Mealtimes were relaxed with people’s preferences and specific diets being responded to.

People were given information on how to make a complaint and said they were comfortable to raise a concern or give feedback. A complaints procedure and comment cards were readily available for people to use. People were encouraged to share their views on a daily basis and satisfaction surveys had been completed. The management style was open and listened to people and staff views. The registered manager was visible, approachable and friendly. Staff enjoyed working at the home and felt supported by the management.

There is a registered manager at the home who is also one of the owners and the provider. 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.

This inspection took place on 16 and 17 February 2016 and was unannounced.

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People were satisfied with the care and service they received and told us they would recommend the home and had done so. People said, “Its lovely I can’t fault it and I tell people so,” and “It’s very pleasant, very nice here I’d thoroughly recommend it.”

Despite having positive feedback from people on the safety and management of the service. We found areas that could impact on people’s safety and care.

Some medicines were not always administered in a consistent and safe way. Guidelines to assist staff in the administration of medicines were not always complete and records of when medicines were administered were not always accurate.

The recruitment practice followed did not always ensure the required checks had been completed for all staff before they worked unsupervised. In addition the required documentation had not been retained within the service.

The management arrangements had not ensured staff had maintained suitable documentation and systems to ensure effective and safe care was always delivered. Auditing and quality monitoring systems were not always effective in identifying areas that needed to be improved.

Feedback received from people their relatives and visiting health professionals through the inspection process was positive about the care, the approach of the staff and atmosphere in the home.

People told us they felt they were safe and well cared for at Queensmead Residential Care Home.

Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. People had access to health care professionals when needed.

There was a variety of activity and opportunity for interaction taking place in the service. This took account of people’s preferences and choice. Visitors told us they were warmly welcomed and people were supported in maintaining their own friendships and relationships.

Staff were provided with a training programme which supported them to meet the needs of people. Staff felt well supported and able to raise any issue with the registered manager.

People were complementary about the food and the choices available. People needed minimal support with eating and staff were positive in their approach to promoting people’s independence.

People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

There was an open culture at the home that supported a friendly and homely environment that people enjoyed.

We spoke with people who used the service and a visiting relative. We spoke with six staff members this included the covering registered manager and registered manager who was returning from maternity leave.

Following the inspection we spoke with a visiting health care professional.

At this inspection we found that issues raised at the last inspection had been addressed. The provider had taken action to ensure staff understood their responsibilities and knew how and when to report any suspicion of abuse. Everyone had care plans that reflected individual needs and staff knew these needs well. Staff training had been strengthened with the management ensuring relevant training was attended.

Since the last inspection a registered manager from a nursing home within the organisation was given responsibility to manage Queensmead Residential Care Home. They had been supported by a registered nurse from the nursing home. Both will be returning to their previous roles as the registered manager returns from leave on the 12 January 2015. However, the registered provider recognised the need for stability and continuity and agreed on-going quality monitoring support from both. This will remain until a deputy managers' appointment and the staffing team feel fully confident with the management arrangements.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We looked at people's care documentation to follow up on specific events and found that the information provided was not consistent. One persons care file did not contain any care plans, however monthly reviews had been completed. Care plans for this person could not be located during our inspection.

We observed a staff handover, this demonstrated that staff knew people living in the home well. Staff were able to give detailed information about each person they had provided care to that morning, and their care and treatment needs. This included exercises people had been assisted with, peoples moving and handling needs and information about people's mood and behaviour that day. However, this was not seen to be backed up with accurate daily documentation.

We saw that the environment was safe. The home had been well maintained. Regular electrical and gas safety checks took place. There had been a recent fire check and legionella risk assessment undertaken.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. There were policies and procedures in place and some staff had received training. Information was seen to be displayed in the manager's office for staff if required.

Staff spoken with including those who we identified on the training matrix as having attended safeguarding training, where vague about safeguarding and did not portray an appropriate level of understanding regarding the types and signs of abuse, or how and when to report concerns in accordance with the homes policies and procedures.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from our observations and from speaking with staff that they understood people's care and support needs and knew people well. We spoke with people living in the home, relatives and visiting professionals. Everyone we spoke with told us they were happy with the standard of care provided. One person living in the home told us 'The girls are lovely.'

Is the service caring?

We observed staff speaking with people in a dignified and calm manner, offering choices and support when required. Staff were seen to respond to people promptly and with patience at all times. Staff knew people's preferences and responded to requests to ensure that people were able to spend their time how they wished. People we spoke with told us that staff were 'Kind and caring.'

Is the service responsive?

Pre admission notes were seen in care files, this meant that people's needs had been assessed before they moved into the home. People or their representatives had been involved in monthly care reviews and consent had been gained when appropriate.

Care files included information about people's lives and significant events prior to moving to Queensmead.

Is the service well-led?

At the time of the inspection the named registered manager was on maternity leave, and an interim manager had taken over the managerial role in their absence. The interim manager had been in post approximately three months. In this time they had implemented a number of changes. This included a new medication provider, staff supervision format and further areas of documentation. The interim manager had an 'open door' policy and staff told us they felt able to contact the interim manager if they had any concerns.

The home employed an activity coordinator. We saw activity plans, and a folder which had been used to document who had attended each activity and whether they had enjoyed it. The activity coordinator also took people out on trips and arranged a variety of quiz's and activities which people told us they enjoyed.

Regular assessment and monitoring of the quality of service had taken place, this included a number of audits and monthly checks. However, not all relevant policies and procedures were up to date.

The home had carried out staff and residents feedback surveys. People we spoke with told us they felt that their views were sought and they felt listened to. we saw evidence of actions taken forward and changes implemented in response to feedback received.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a team who had appropriate knowledge and training in safeguarding adults. People told us that if they had any concerns they would report them to the manager or senior person on duty.

Staff received ongoing training and supervision which provided them with skills and knowledge to meet the needs of the people they were supporting.

The provider had effective systems in place to monitor and assess the quality of the service.

During the visit we had many opportunities of observing staff providing care to the people who resided at the home. We heard them speaking to residents in a professional, sensitive, gentle, calm and quiet manner whilst promoting their independence.

During the visit we had many opportunities of observing staff providing care to people. We heard them dealing with residents, relatives and visitors in a professional, sensitive, calm and quiet manner. As we walked round the home we were introduced to residents and care was taken by staff to ensure that they understood the purpose of our visit.

People living at the home were very complimentary about the care and support they received. One resident told us that she could not fault the care she received at the home. Another said 'staff are professional and approachable and we chose here because of how caring the staff were'. People were keen to talk with us and said they felt safe and protected from the risk of abuse. One person told us 'I know that the staff do everything to look after me and my family are happy that I am safe'.