Queensbridge House

Queensbridge House is a residential care home providing accommodation and personal care to up to 27 people. The service provides support to younger people who live with complex mental health. Some of whom receive treatment under the Mental Health Act 1983 and some have also offended and been through the criminal justice system. The service supports these people to step down from more secure settings such as prison or secure mental health units, to live again in the wider community. The service also supports older people who live with dementia.

At the time of our inspection 8 people with mental health needs and 6 people with dementia care needs were receiving support. People were accommodated in 1 adapted building on 2 separate units according to their needs.

This was a targeted inspection which only reviewed safe ways of working on the mental health unit. Based on our inspection the provider had taken action to improve people’s safety; care was planned and delivered safely.

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

The provider had reviewed their policies and procedures and amended these to further support safe ways of working and to uphold people’s human rights. All staff spoken with had a good understanding of the provider’s policies and safe ways of working guidance.

People’s risk assessments and care plans had been reviewed and improved. Assessments and care plans provided staff with clear guidance on how to support people safely, in accordance with the provider’s policies and procedures.

Staff had received additional training to underpin their knowledge. All staff spoken with had a good understanding of people’s needs and how to reduce risks to people.

People’s care and support had been reviewed by commissioners of care. Health care professionals were involved in developing and monitoring people’s care. We spoke with one visiting health care professional who was happy with the care being provided by the service to their patient.

Action had been taken to improve the safety of the environment. This included systems in relation to fire and environmental safety.

At the time of the inspection, we observed people receiving the care which supported their mental and physical wellbeing.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 August 2023).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to review the immediate action taken by the provider, to improve people’s safety, following our inspection on 3, 4 and 22 May 2023. At this inspection we have not followed up the breaches of regulation identified in the inspection.

We use targeted inspections to follow up specific areas of enforcement or concern. Targeted inspections do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

This inspection only looked at certain areas of the safe key question. Please see our findings under this section in the full report.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We found no evidence, during this inspection, that people were at risk of harm from the concerns identified in our previous inspection (3, 4 and 22 May 2023).

You can read the report from our last inspection, by selecting the ‘all reports’ link for Queensbridge House on our website at www.cqc.org.uk.

Follow up

We will review the action plan from the provider in relation to the last inspection to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Queensbridge House is a residential care home providing accommodation and personal care. It is currently registered with the Care Quality Commission to support a maximum of 27 people.

The service supported younger people who live with complex mental health needs. Some received treatment under the Mental Health Act 1983 and some also had forensic backgrounds. This meant they had offended and been through the criminal justice system. The service supported people to step down from more secure settings such as prison or secure mental health units, to live again in the wider community.

The service also supported older people who lived with dementia. At the time of our inspection 8 people with mental health needs and 6 people with dementia care needs were receiving support.

People were accommodated in one adapted building on two separate units according to their needs.

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

The provider had not adhered to their admissions and referral policy regarding the admission of people with mental health needs. This had resulted in the admission of some people with behaviour and risks which the provider’s policy stated the service could not meet.

We made a recommendation in relation to what needs to be considered when supporting people with complex mental health needs and forensic backgrounds.

Risks associated with people’s mental health and complex histories had not been sufficiently assessed and action taken to mitigate risks and keep people safe. People’s care records, which included risk assessments and care/support plans did not always provide staff with the detail they needed to be able to support people safely. There was limited guidance, for example, on when restraint maybe applied and what action staff should take to de-escalate people’s distressed or challenging behaviour, effectively and safely.

The environment had not been adequately assessed or managed in a way which ensured people’s safety. Risks related to fire, falls from windows, substances hazardous to health and ligature points were not sufficiently managed to ensure people’s safety.

Incidents were not always identified as needing to be reported to external agencies or as part of the provider’s incident reporting process. This meant incidents had occurred without relevant agencies awareness and therefore ability to follow these up to ensure, people were safeguarded, or that appropriate action had been taken to ensure people’s safety. The provider had not effectively monitored incidents to ensure they were appropriately reported and managed.

People’s medicines were not always managed safely.

On the mental health unit care/support plans were not sufficiently developed to show people’s care had been planned, developed and reviewed with people’s collaboration, and in accordance with necessary national standards and best practice guidance. People’s records relating to their care needs lacked detail for staff on how they should support people.

The provider did not have effective governance arrangements in place. The services policies, procedures and practices were not always aligned to relevant national guidance and standards for the care and support of those with complex mental health needs and forensic backgrounds. The provider did not have effective systems or processes in place to assess and monitor the safety and quality of the services provided. Many of the shortfalls identified during this inspection had not been identified through the provider’s own monitoring processes. There were ineffective arrangements in place to drive improvement.

People on the mental health unit were provided with opportunities to take part in activities which supported their physical and social wellbeing. However, there were limited structured and therapeutic activities. For example, unless incorporated into a person’s treatment plan by commissioners, people did not have access to a trained counsellor or psychologist.

Records required to be kept were not always completed or maintained making it difficult for the provider to effectively audit and drive improvement. This included records related to incidents, complaints and cleaning.

On the dementia care unit, people’s risks were assessed and necessary actions taken to reduce and manage risks. The action staff needed to take to support people was incorporated into people’s care plans for staff guidance. This included, for example, needs associated with risks of falls, pressure ulcer development, malnutrition and choking.

People were supported to make choices and to regain control of their lives. People were supported in the least restrictive way possible and in their best interests.

People on the mental health unit told us they felt safe and well supported. We spoke with the relatives of people who lived on the dementia care unit and they told us their relative was safe and the care provided benefited them and suited their needs.

People and their representatives knew who the registered manager was, and they found them to be helpful and supportive. People’s representatives told us communication from the staff, about their relative, could be improved; this was not always forthcoming unless they asked first.

We found the environment to be clean and people’s representatives confirmed the environment was always clean when they visited, although poorly decorated.

Relatives told us there had been limited opportunities for providing formal feedback. However, they told us if they needed to raise a complaint or concern, they were confident this would be acted on. Feedback was sought from people who used the service, on an individual basis. There was no evidence to show there were opportunities, such as organised meetings, for people and relatives to provide feedback and make suggestions for improvement.

Staff told us the registered manager and senior staff were supportive and there were arrangements in place to formally support staff.

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 11 April 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. This included the provider’s decision to add mental health needs to the needs the service stated it would meet and an incident involving medicines.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook a focused inspection to review the key questions of safe, responsive, and well-led. This inspection therefore only covers our findings in those key questions. We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Queensbridge House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the assessment of risks, planning and delivery of safe care and treatment, person-centred care and the governance of the service, at this inspection.

Please see the action we have told the provider to take at the end of this report.

In response to our inspection findings we (the Care Quality Commission) have applied conditions to the provider’s registration which require the provider to seek agreement from us prior to admitting people to the service. We also required the provider to ensure care plans for people with mental health needs, gave staff enough detail to ensure they could support people in line with the care commissioned by commissioners and people's assessed needs.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety.

We will work with the provider and local authority to monitor progress on the action taken by the Care Quality Commission in relation to this inspection. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Queensbridge House is a residential care home. It specialises in the care of people who live with dementia and mental health needs. It can accommodate up to 27 people, although at the time of the inspection 26 people were receiving care (a bedroom which can accommodate a couple where needed was being used by one person).

People’s experience of using this service:

• The service demonstrated a strong, visible person-centred culture and followed a model of dementia care called the ‘Butterfly Approach’. People therefore received highly personalised and exceptionally caring, kind and empathic care from staff

• People’s feelings, wishes and wellbeing were at the centre of their support. People were afforded time and emotional support to help them maintain their wellbeing. Staff were particularly ‘tuned into’ people’s moments of illbeing and distress and provided positive and emotional support at these times.

• Staff demonstrated exceptional compassion, understanding and kindness towards people when supporting them. A nurturing culture helped people to feel safe and to develop meaningful and beneficial relationships.

• Staff were developed and supported to be skilled and motivated in helping people to live well with dementia. Improving people’s quality of life was at the centre of all interactions and activities provided by the staff.

• Activities were meaningful and fun, they were person - centred and were aimed at maintaining individual skills and achieving a sense of purpose and achievement. They were used to support social connections between people.

• People and staff lived and worked as one supportive ‘household’ caring for and valuing each other’s contribution. Staff recognised and valued the importance of those who were close to people; family and friends. They were supported to feel part of the ‘household’ and to remain part of people’s lives.

• People’s representatives (where appropriate) contributed to people’s care and the decisions made on their behalf.

• The home’s environment was domesticated and adapted to help people orientate and connect to their surroundings.

• People’s care records had improved. Records reflected people’s needs, the care people received and gave detailed guidance to staff on how to meet people’s needs.

• Risks to people were identified, assessed and managed effectively. We have made a recommendation in relation to guidance available to staff when supporting people following a fall who have also sustained a head injury and who are on a blood thinning agent.

• People and their relatives benefited from the home being managed in an open and transparent way. There had been a change of manager in August 2017 when the deputy manager became the registered manager of the service.

Rating at last inspection:

At the last inspection on 26 and 27 October 2017 the service was rated Requires Improvement. This report was published on 2 February 2018.

At our last inspection we found people’s records were not always comprehensive and the provider’s quality assurance systems had not identified this concern. Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions, Is the service responsive and well-led? The overall rating for the service has improved from Requires Improvement to Good.

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We also followed up on progress against agreed action plans to address the breaches in regulation we found at our previous inspection in October 2017. Previous CQC ratings and the time since the last inspection were also taken into consideration.

The overall rating for the service has improved from Requires Improvement to Good.

Follow up:

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

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

Queensbridge House is set over two floors. It has four lounge/dining room areas with a variety of seating and objects of interest and a secure back garden. The home also offers a day centre service.

A registered manager was in place as required by their conditions of registration. A second manager had also recently registered with CQC to support the established registered manager in managing the home. 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.

At the last inspection in September 2016 we rated the service as ‘Requires improvement’. As a result of this inspection, we found the service had not improved in its rating and continues to be rated as ‘Requires improvement’. Under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we will be asking the provider to send us a written report of the action they plan to take to achieve a rating higher than ‘Requires Improvement’ to support us to monitor the provider’s planned improvements.

People received care and support from staff who were knowledgeable about their support needs and preferences. However people’s care records did not always provide staff with the information they needed to support people. The records of the management and monitoring people‘s risks and their medicines did not provide staff with sufficient guidance. People’s consent to their care or the outcome of mental capacity assessments were not reflected clearly in people’s care plans. Records showed that people’s health care needs were monitored and any changes in their health or well-being had prompted a referral to their GP or other health care professionals.

Relatives highly praised the caring nature of staff and told us they were always welcomed at the home. There were many warm and genuine interactions between staff and people. Staff treated people with dignity and respect. People and their relatives told us they felt safe living at the home. They told us they enjoyed their meals and were supported to eat a healthy diet and have plenty to drink. People enjoyed activities in the home.

Staff had been trained in their role and felt supported by the managers. The registered managers worked alongside staff providing care which gave them a good insight into people’s needs and skills of staff, although their assessment and observations of staff were not effectively recorded or monitored. Staff were aware of their responsibilities to report any concerns of abuse or harm. There were sufficient numbers of staff who had been suitably recruited to support people.

A new management structure provided people and staff with confidence in the management of the home. People and their relatives were confident that any concerns would be dealt with promptly. Quality assurance systems were being implemented and reviewed to evaluate the quality of care being delivered, although had not identified gaps in the details of people’s care records. We have recommended that the service reviews the systems that monitor people’s care records.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what action we told the provider to take at the back of the full version of this report.

Queensbridge House is set over two floors. It has four lounge/dining room areas with a variety of seating and objects of interest and a secure back garden. The home also offers a day centre service.

A registered manager was in place as required by their conditions of registration. 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 enjoyed living at Queensbridge House. Relatives were complimentary about the caring nature of staff. Staff approached people in a kind and caring manner. They had all been trained in the ‘Butterfly Approach’ which is a way of supporting people living with dementia by focussing on their emotional needs. Staff ensured people received care and support in accordance to their preferences and needs. People’s privacy and dignity was respected.

There were sufficient amount of staff to meet people’s needs. Staff told us they felt supported and well trained, although they had not consistently received regular private support meetings or staff meetings. The registered manager was actively recruiting new staff. Safe recruitment practices where followed to ensure suitable staff were employed, although we have made a recommendation about safe recruitment practices.

People’s care and support needs were documented. People were supported by staff who respected their human rights and encouraged them to make decisions about their care. They were provided with a variety of activities to meet their social needs. Staff were confident about recognising and reporting suspected allegations of abuse although they were not always clear about who they would report their concerns to outside the organisation.

There were safe systems in place to manage people’s medicines. People received their medicines on time by staff who were trained to carry out this role. People’s care records showed relevant health and social care professionals were involved with people’s care. Peoples nutritional and hydration needs were appropriately assessed and monitored. People’s specialist dietary needs were catered for.

Quality monitoring systems were in place to identify any shortfalls in the service although the processes lacked evidence if actions had been taken to address the areas of concern. The registered manager sought feedback from people however there was no evidence that the results of the feedback had been acted on.

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

We looked at the care records of five people living in the home to see how they were being supported to make decisions. At the time of our visit, the provider told us that people living in the home had the capacity to make simple day-to-day decisions. Staff were experienced in providing care to older people and used language that could be understood by people with dementia and fluctuating capacity.

The provider assessed, planned and delivered care and support to meet people's needs. Identified risks associated with the provision of care were assessed and managed to ensure people's safety and welfare.

Health and social care professionals carried out specific assessments to determine how people's current and future needs could be met. People's needs continued to be met when they moved between services and when they moved into the home.

A sufficient number of staff worked across all shifts. Staff told us they had enough time to assist people to get up in the morning, eat their meals and with chosen activities.

People who used the service, their representatives and staff were asked for their views about their care and treatment provided and these were acted upon. The provider routinely reviewed the service provided and took account of incidents and outcomes of investigations to identify where improvements were required.

People said that they were able to make choices about their personal care and make choices about the food that they had.

People in the home and their relatives said that the care was good. The individuals who used services said that they felt safe and secure and listened to. People living in the home that if they had any concerns they felt they could go to the manager and these concerns would be dealt with.

We observed that appropriate assistance was being received by individuals when required.

Surveys were being undertaken to seek the views of people using the service but these required development into a clear audit trail of evidence.

Staff training and support was in place to ensure that the individuals were being cared for by appropriately trained and supervised staff.