Archived: Quarry House

We found the following examples of good practice.

Prior to our visit we were informed of the procedures we should expect when visiting, this was the policy for all professionals arriving at the service. Professionals were asked not to visit the service if they displayed any symptoms related to Covid 19. On our arrival we were greeted by the receptionist and had our temperature taken, we were asked to sanitise our hands and to wear the PPE given to us. Everyone visiting provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained strong. One professional was happy for us to share their recent experience when visiting the home. They wrote to the registered manager, “The manner in which you and your team handled the recent case of a Covid positive patient was excellent. The patient was identified as having a relevant symptom and a Covid test was rapidly arranged by the home. The staff were all wearing the appropriate PPE when I've been at the home and are aware of the isolation procedures you have in place and actioned them accordingly. I was very impressed at how well everyone at Quarry House handled this patient's care”.

The emotional wellbeing of staff, people and their families had been supported throughout the pandemic. The whole team ensured contact and support was maintained through various initiatives. Staff were sensitive to people’s feelings including anxiety, sadness and loss. As the autumn winter season was approaching the provider had considered alternative visitor arrangements. Each person had been individually risk assessed to ensure visits were person centred. This would help ensure their visits were meaningful whilst maintaining their safety, meeting needs and respecting privacy. A designated member of staff was available should anyone during the visit require assistance, for example if they needed to use the bathroom facility. One relative recently wrote the registered manager and said, “Visits are so terribly difficult not being able to hug mum, but we are so grateful to all the wonderful staff who do a fantastic job. I cannot praise them highly enough. We have peace of mind knowing our loved ones are being well cared for. They make visiting as comfortable as possible during this difficult time”.

Staff welfare and mental health was paramount in ensuring they received the kindness and support they required as individuals, so that they felt valued. Staff were encouraged to complete a wellbeing questionnaire based on NHS guidance. Wellbeing needs both as employees and on a personal level were always considered and respected. Staff had access to videos raising awareness on the importance to look after your mental health and a charity provided counselling to staff if required. Other initiatives and acts of kindness included, gift boxes, hampers and coffee mornings. Additional training on the effects of end of life care supported staff and workshops to cope with grief, loss and bereavement were also provided.

All staff recognised their responsibility to protect the people they cared for and how crucial it was that when they were not at work, they respected and followed government guidelines to reduce their own exposure to risks. The registered manager and deputy were very proud of all staff and recognised and celebrated their efforts during the pandemic.

When people were admitted to the home, risk assessments were completed, and people were isolated for 14 days. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly.

There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received IPC training and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of PPE and infection prevention and control practices. There was effective, supportive communication between the directors, all managers, staff, people living at Quarry House and their relatives.

Quarry House is registered to provide accommodation for up to 65 people who need nursing or personal care. At the time of our visit, 61 people were living in the home. The home is arranged over four floors. Each floor is separated into two units. A central staircase and two lifts provide access to each floor. The provider is also registered to provide personal care to people living in self-contained purpose-built apartments next to the home. At the time of our inspection one person living at those apartments received the regulated activity personal care.

The registered manager had been in post since July 2017. 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 inspection of October 2017 significant improvements had been made but further improvements were required. We also needed to be satisfied the improvements that had been made would be sustained. We found that management of medicines required further improvement and risks assessments required more detail to protect people from unnecessary harm. Training had improved but staff still required training in how to care for people with dementia. Consent to treatment and support was not clearly evidenced. Systems in place to monitor and evaluate the service needed to improve. Following the inspection, the provider sent us an action plan explaining how they would address our concerns and what action would be taken.

At this inspection we found continued significant improvements had been made and all previous breaches in regulations had been met. This meant the overall rating of the service had changed from Requires Improvement to Good.

Why the service is rated good

People now received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks, promote their independence and follow their interests. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed. The home was exceptionally clean and staff followed infection control procedures.

Improvements had been made to promote and provide an effective service. Staff received supervision and the training required to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

The service remained caring and put people at the heart of everything they did. We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was extremely positive throughout. Those people who used the service expressed satisfaction and spoke well about the staff. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

The service continued to be responsive. People received person centred care and support. Regular monitoring and reviews meant that referrals had been made to appropriate health and social care professionals. Where necessary care and support had been changed to accurately reflect people's needs and improve their health and wellbeing. People were offered a range of activities both at the service and in the local community. People were encouraged to make their views known and the service responded by making changes.

The service had improved and people benefitted from a service that was well led. The director, registered manager, deputy and staff team maintained a clear focus on continually seeking to improve the service people received. Good quality assurance systems were in place and based upon regular, scheduled audits. These identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and, where shortfalls were identified they were acted upon.

Further information is in the detailed findings below.

Quarry House is registered to provide accommodation for up to 65 people who need nursing or personal care. At the time of our visit, 61 people were living in the home. The home is arranged over four floors. Each floor is separated into two units. A central staircase and two lifts provide access to each floor. The provider is also registered to provide personal care to people living in self-contained purpose built apartments next to the home. At the time of our inspection no-one living at those apartments was receiving personal care.

At our last comprehensive inspection in September 2016 we found breaches of four of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as Requires Improvement. Following that inspection we told the provider to send us an action plan detailing the measures they would take to make the necessary improvements.

We then carried out a focussed inspection in July 2017. The purpose of that inspection was to follow up on safeguarding concerns shared with us. As a result we inspected and reported upon whether the service was safe. We found the service required improvement in that key question area and identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our inspection we told the provider to submit a further action plan detailing the measures they would take to make the necessary improvements.

Overall, at this inspection we found improvements had been made and many of the actions detailed in the provider’s action plans achieved. However, we found improvements were still required to ensure the service provided to people is consistently safe, effective and well-led.

There was no registered manager in post. 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. The previous registered manager had left the service in July 2017. A new manager commenced in July 2017 and has submitted an application for registration to the Care Quality Commission.

People were not always kept safe because medicines were not well managed. Medication administration records were not always completed. This meant it was not possible to be sure people had received their medicines as prescribed. Guidance for when people should be offered PRN (as required) medicines, did not provide enough detail. The recording and storage of medicines was not thorough enough to ensure safety at all times.

The service had not consistently complied with the requirements of the Mental Capacity Act 2005 (MCA). People’s capacity to make their own choices and decisions had not always been assessed. Where people had been identified as not having the capacity to make a particular decision, decisions made on their behalf were not always arrived at in a manner consistent with the principles of the MCA. Some people were being deprived of their liberty without this being correctly identified and authorisation applied for.

Staff received basic induction and update training but had not had training to equip them with the knowledge and skills to effectively care for people living with dementia.

Quarry House is a newly built modern facility that following registration with CQC opened in January 2016. It was well equipped and the physical environment was clean and fresh. However, it was lacking in stimulation for older people and particularly those living with dementia. The provider and manager had identified some ideas for improving this. In order to best make progress with this, the manager and provider should consider reviewing their action plan detailing the changes they intend to make.

Individual risk assessments and management plans had improved, although some required further detail to ensure people were kept safe. Some people’s care and support plans also required further detail to ensure they described the person centred care they would receive. These were areas the manager and senior staff were addressing on a planned basis and, some had been reviewed and did provide sufficient detail.

People were supported by sufficient numbers of staff. Checks were carried out on staff before they started work with people to assess their suitability to work with vulnerable people. Staff understood their role and responsibilities to keep people safe from harm and had received training on safeguarding vulnerable people.

Staff were kind, caring and knew people well. They treated people with dignity and respect and were sensitive to their needs. On both days of our inspection we observed a number of positive interactions between people and staff and, saw how these contributed towards people’s well-being. People were offered a range of well-planned group and individual activities. Effective links had been established with community groups to provide a wider range of activities for people and reduce the risk of social isolation.

People were supported to see a GP and other healthcare professionals when they needed to do so. People were able to choose the food and drink they wanted. The manager and other senior staff were well liked and respected and had some plans in place to improve the service people received.

We found breaches of four separate regulations 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 the report.

We undertook this focused inspection to ensure that people living in the home were safe, and that there were sufficient staffing arrangements in place to make sure people’s care needs were being met. This report only covers our findings in relation to these areas. When we last inspected Quarry House, in September 2016, we found that staffing was insufficiently deployed and did not always meet people’s care and treatment needs. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Quarry House on our website at www.cqc.org. The current overall rating for the home is ‘Requires Improvement.’

Quarry House is registered to provide accommodation for up to 65 people who need nursing or personal care. At the time of our visit, 61 people were living in the home.

There was no registered manager in post at the time of our visit. The current manager had commenced in post in January 2017. They were leaving Quarry House on 21 July 2017. Another manager had started one week before our visit. They told us they would be applying to the Care Quality Commission, (the Commission), to be the registered manager for the service. 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 who used the service and their relatives provided mixed feedback about staffing. Staff were not always confident they could meet the care needs of people living in the home. Staff were also concerned that further changes in management would affect the support they received.

Staff were not always sufficiently deployed to provide the care and support people needed and when they needed it.

We found there continued to be a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we had identified at our last comprehensive inspection undertaken in September 2016. You can see what action we told the provider to take at the back of the full version of the report.

There was a registered manager in place at the time of 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.

Staff were not always deployed where they were needed to meet the needs of people living in the care home. Care was sometimes rushed and staff told us they did not always have time to provide the care people needed.

People’s medicines were not always managed safely. We found that incidents and accidents were not fully reviewed and insufficient actions were taken to minimise future risks to people.

Staff had not received sufficient training to carry out their roles effectively. Staff had not received training to ensure they could always meet people’s needs and care for them in a safe way. There was inconsistency in the knowledge and understanding staff had about Deprivation of Liberty Safeguard (DoLS). Staff were not all aware of people who had authorisations in place or who had conditions attached to authorisations. This meant people rights may not be fully protected.

People and their relatives spoke positively about the staff and told us staff were kind, caring and respectful. We spoke with staff and with relatives who told us staff did not always get to know about people’s individual needs and preferences because staff were often moved to work in different areas of the home.

There was a range of group activities that people could participate in and people were enjoying group activities on the days of our inspection.

Quality assurance systems were partly in place. These had identified some, but not all of the issues we identified during the inspection.

We found multiple breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.