Queensbridge House

Updated 19 September 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to review the immediate actions taken by the provider to improve the safety of the service following our May 2023 inspection.

Inspection team

One inspector carried out this inspection with the support of a CQC senior specialist (mental health).

Service and service type

Queensbridge House is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Queensbridge House is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We reviewed 4 people’s care records which included care plans and risk assessments. We spoke with 5 staff, which included the registered manager, deputy manager, 1 administrator/support worker and 2 team leaders. We also reviewed 3 policies and records and actions taken in relation to the environment.

Updated 19 September 2023

About the service

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.