Archived: Queensmead

Queensmead is a residential care home providing accommodation and personal care to older people, some of whom are living with a dementia. Accommodation is provided over three floors and includes communal social and dining areas. There are a range of specialist shower and bathrooms and a passenger lift providing access to the first and second floors.

People and their families were being kept up to date on COVID-19 related government guidance, which included care home visiting. The home was experiencing a COVID-19 outbreak at the time of our inspection which meant restrictions on visiting arrangements. Arrangements included people having a relative or friend as a nominated essential care giver, (ECG), who was able to visit to provide emotional and physical support. The manager told us that only two people had ECG’s in place and agreed to share details again with people and their families to ensure they understood their visiting rights. Other visiting arrangements taking place included window visits and telephone and video calls. One person told us, “When my family visit they can use the conservatory or come to my room.”

Staff and visiting professionals were following the vaccination and testing requirements. People living at Queensmead had taken part in the vaccination and testing programme. If people had been assessed as not having the capacity to make this decision a best interest decision had been taken in order to ensure their rights were protected. Risk assessments were in place for people and staff who had a higher risk of serious illness and actions in place to mitigate risk.

The building and equipment were clean and in good order. One person told us, “It’s always lovely and clean here.” Changes to communal areas to enable social distancing included replacing sofa’s with armchairs and creating distancing between furniture.

Staff had access to appropriate PPE, which was in good supply, and observed to be worn correctly. Staff had completed infection, prevention and control training, which included correct putting on and taking off and handwashing techniques. Competencies were regularly checked.

Latest government guidance was being followed for admissions, including any testing and self-isolating requirements. Staff understood their role in supporting people’s emotional well being and provided increased one to one support where people were unable to socialise or join group activities. Staff had access to a range of well being support including external, confidential counselling services.

Governance arrangements included regular audits and surveys gathering feedback from people and the staff team. An infection, prevention and control policy was in place, accessible to the staff team and kept up to date with new guidance.

Queensmead 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Queensmead has a registered manager but they had transferred to another location and so were not present during our inspection. 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 our inspection a manager had been appointed who was overseeing the service and would be making a registered manager application to CQC.

People and their families described the care as safe and were safeguarded as staff understood their role in recognising and reporting any concerns of abuse or poor practice. Staff had been recruited safely with checks including their suitablility to work with vulnerable people. People were protected from discrimination as staff respected people’s individuality. Staffing levels were flexible which meant they were able to respond to people’s changing care needs. Staff had completed an induction and had on-going training and support that enabled them to carry out their roles effectively.

People had their risks assessed and were involved in decisions about the actions needed to minimise risks of avoidable harm. Staff were knowledgable about people’s risks and understood their role in keeping people safe from harm. Staff understood the actions they needed to take to minimise the risk of preventable infections. Medicines were ordered, administered, recorded and disposed of safely by trained staff that had completed medicine administration training. Accidents, incidents and safeguardings were reviewed to see how service delivery could be improved and when actions had been identified they were dealt with in a timely way.

Pre admission assessments had been completed that captured people’s needs, choices and equipment required. This information had been used to create person centred care plans that reflected people’s individuality and life style choices. People felt involved in decisions about their care and were involved, with their families when appropriate, in care reviews. Working with other agencies such as district nurses and community mental health teams enabled effective care to be provided. People were supported to access healthcare both in planned and emergency situations. People had opportunities to be involved in their end of life planning and had their last wishes respected.

People had their eating and drinking needs understood by both the catering and care teams. People enjoyed the food and were offered choices at mealtimes with snacks and drinks available throughout the day and night. When people had risks associated with choking safe swallowing plans were in place and followed.

The building and secure gardens were accessible to people and provided opportunities for both social and private time. There was a lack of signage around the home such as the location of toilets which impacted on some people’s ability to orientate themselves independently around the home.

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 supported this practice. Working with other professionals had enabled people to get the care and support they needed including appropriate equipment and access to healthcare. A complaints procedure was in place that people felt able to use and be listened to with actions taken to solve any issues.

People spoke positively about the level of care and had their privacy, dignity and independence respected by the staff team. We observed kind, patient, friendly interactions with people and staff demonstrated they understood people’s communication needs.

The culture of the home was open and friendly with people, their families and the staff team feeling able to contribute to the development of the service. Staff understood their roles and responsibilities, spoke proudly of teamwork and felt appreciated in their roles. Auditing processes were robust and provided effective oversight of service delivery enabling actions to be taken when improvements were identified. Partnerships with other organisations enabled continual learning and provided best practice guidance that supported good standards of care.

Queensmead is a residential home that provides care for up to 40 older people some of whom are living with a dementia. At the time of our inspection there were 40 people living at the service. People had their own bedroom and shared bathrooms, a lounge, conservatory, dining room and gardens. The home has 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.

Pre-employment checks were undertaken. However, gaps in employment history had not always been fully explored. One member of staff, who had started work on a DBS First check of the barred list. This member of staff had a criminal conviction and a risk assessment had been completed which incorrectly indicated that a full DBS had been received when it was still pending.

We discussed this with the registered manager and director who told us they would ask their human resources team to review the process immediately.”

There were enough staff to meet the needs of people including during periods of staff holiday or absences.

Staff had the knowledge and skills to recognise potential risks of abuse to people and actions they needed to take if they suspected abuse. Risk assessments had been completed and where risks had been identified there was a plan in place that described actions that were needed to minimise the risk. People had been involved indecisions about risks and had the freedom and choices to live in ways they chose. Processes were in place to manage any unsafe practice.

People received their medicines safely.

Staff received an induction and ongoing training that enabled them to carry out their roles and responsibilities. They were supported and had regular supervision. They had opportunities for personal and career development.

Staff demonstrated a good understanding of consent ensuring people had choices about how they lived. Mental capacity assessments had been completed and people were being supported in the least restrictive way. Files contained copies of power of attorney (POA) legal arrangements for people and staff understood the scope of decisions they could make on a persons’ behalf.

People received the care and support they needed to eat and drink safely. Staff had a good understanding of people’s eating and drinking requirements and

any identified risks had been included in people’s nutritional care plans. Referrals had been made to the GP, dietician or a swallowing and language therapist (SALT) when needed.

People had good access to healthcare including district nurses, physiotherapists and specialist health professionals.

We observed positive caring relationships between staff and the people. People had call bells and drinks in their rooms. Staff had a good understanding of people’s interests, likes and dislikes.

People were involved in decisions about their day to day life. People had their dignity respected. Staff positively encouraged and supported people to maintain their independence. Information was available on advocacy services people could access if they needed somebody to speak on their behalf.

The home was registered with the Gold Standard Framework for end of life care and had achieved beacon status. The Beacon status is the highest award in the Gold Standards Framework programme, for end of life care. This meant that people could expect their physical, spiritual and emotional needs met with a focus on the management of symptoms, comfort, dignity, and respect.

Care plans included information that was specific to individuals and detailed their care preferences.

Staff had a good understanding of the support people needed. Care plans were reviewed at least monthly. People were supported to carry out activities that were meaningful to them and supported to achieve personal goals. Links with the community had been maintained.

A complaints procedure was in place and included details on how to escalate a complaint. This included CQC the local authority and local government ombudsman. We pointed out to the provider that CQC do not deal with complaints although we encourage people to contact us at any time. The provider changed their literature immediately to reflect our comments.

The service was well led and had a positive culture that enabled staff to feel part of the team and empowered. Communication was effective with people, staff and other professionals. Staff had opportunities to discuss ideas or concerns and felt listened too and appreciated. They understood their roles and responsibilities and the level of decisions they were able to make.

The registered manager had developed links with the community and was involved in a local dementia friend’s strategy group for Christchurch.

Audits had been carried out by that effectively captured the level of detail sufficient to provide reliable data and lead to positive change. A quality assurance survey had been completed in November 2015. The service was liaising with a local university to produce a bespoke dementia friendly survey that will better capture feedback from people living with a dementia.

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.

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?

Staff records demonstrated that the staff had regular training and staff we spoke with told us that they received regular supervision and annual appraisals. They also told us they felt they had the skills to meet people's needs and our observation of staff confirmed this.

Staff training records showed that staff had been trained in safeguarding vulnerable adults. Staff we spoke with where able to tell us about the different types of abuse and were aware that they should report any concerns to the home manager or local authority safeguarding team.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager advised us that people were subject to Deprivation of Liberty Safeguard (DoLS). We saw documentation that showed that the staff were following the correct procedure and that policies and procedures were in place.

Is the service effective?

During our visit we observed that staff provided support and engaged with people positively. People appeared relaxed and comfortable in the presence of staff. Speaking with staff it was evident that they understood individuals’ care and support needs. We saw that care plans were based on people’s assessed needs and that risk assessments had been completed and were regularly reviewed.

Is the service caring?

People told us that they were happy with the care they received and felt their needs had been met. We saw staff treated people in a sensitive, respectful and professional manner. People’s privacy and dignity was respected. In people’s care plans we saw that there was information about what they needed help with and how staff should support them. One person told us that they “were settled here”. A relative told us that “The care is very good and the staff keep us informed”.

Is the service responsive?

People’s needs were assessed before they moved into the home. Care plans covered all aspects of people’s care needs and were reviewed regularly. We observed that during the handover all the individuals were discussed which ensured that staff were updated about the support people received.

Is the service well-led?

The home had quality assurance systems in place. These included annual rolling audit which covered all aspects of the home. The home had regular meetings with the staff and these included meetings with the full staff team, the care staff, night staff, housekeeping staff and catering staff. The home also held regular meetings with the people living at the home and their relatives giving them opportunities to provide feedback and opinions about how the home was run.

We spoke to five people living at Queensmead and used a number of different methods to help us understand people's experiences of living in the home.

We spoke with six members of staff and two visitors for their views about the home and the care and support their relatives received.

All of the people and relatives we spoke with expressed satisfaction with the service provided. People told us that staff were "very friendly". One person said "I got my confidence back". A visitor told us that they had "no concerns" about the care provided for their relative.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

People were protected from the risks of inadequate nutrition and dehydration.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

The provider had suitable quality assurance procedures in place to manage the health and welfare of people living in the home. People were able to comment on the service provided.