Archived: Qu'Appelle Care Home

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

People were not protected from avoidable harm because risk assessments and care plans were not up to date and did not always identify risk. Staffing numbers were not sufficient to meet people’s needs or keep them safe. Staff did not have time to monitor or supervise people who required this. Some people did not have enough to eat or drink and this was not identified, and no action was taken.

The premises and environment were poorly maintained, and this put people at risk of harm. Action required identified in the providers own fire risk assessment had not been taken. Staff had not had evacuation training and there were not enough staff to keep people safe in an emergency situation. Lincolnshire Fire and rescue service visited the service the day after our inspection and served a prohibition notice. This meant the fire service was of the opinion the use of the premises would involve serious risk to people and should not be used.

Infection control policies and procedures did not protect people from infection because government guidance was not always followed. Risks associated with COVID-19 had not always been identified or assessed.

There was a lack of formal oversight from the provider, who had failed to identify the concerns found during our inspection. Quality assurance audits were not always carried out or were ineffective. Staff had not received the training and support they required. People were not consulted about their care and support. People were not protected from the risks associated with receiving care and support.

Rating at last inspection

The last rating for this service was inadequate (published 20 May 2021). At this inspection, not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This inspection was carried out to check whether the Warning Notice we previously served in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. We also received concerns in relation to staffing numbers and safety. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

Enforcement

We have identified breaches in relation to safety, staffing numbers, quality monitoring and governance.

We cancelled the provider's registration.

Follow up

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

Qu’Appelle is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

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

Medicines were not managed safely and in line with best practice guidance. People did not always receive their prescribed medicines. Staff did not always receive medicine training in line with best practice guidance and staff competence was not clearly assessed.

Environmental risks were not managed effectively which increased the likelihood of people tripping and falling. There were no formal themes and trends analysis of accidents and incidents which took place in the service.

Staff did not always wear their personal protective equipment (PPE) correctly which posed a risk of infection. Risks associated with COVID-19 had not always been identified, assessed and mitigated.

The provider failed to ensure a quality assurance or governance policy was in place. Quality assurance audits were not always carried out. Audits which were conducted were not effective in identifying shortfalls or areas for improvement. Some areas of the quality assurance audits were not completed accurately.

People’s needs were not reviewed regularly, which meant safe staffing levels were not calculated accurately.

Training data did not assure us staff were adequately trained.

There was a lack of formal oversight from the provider, who had failed to identify the concerns found during our inspection.

Other risks relating to people’s health conditions had been assessed and information was available to staff. Staff understood safeguarding and how to keep people safe.

Staff felt supported by the service’s internal management team.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 10 March 2020)

Why we inspected

We received concerns in relation to the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to aspects of people’s safety and the governance, and oversight of the service.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Qu’Appelle Care Home is registered to provide accommodation and support for up to 36 people, including people living with dementia. There were 24 people living in the home on the first day of our inspection.

People’s experience of using this service:

We found service quality had improved since our last inspection, although some further action was still required to ensure a consistently safe and well-led service.

There were shortfalls in the systems used to monitor service quality and action was required to ensure people’s individual risk assessments were updated to take account of changes in their needs.

The provider had failed to comply with an additional condition of registration and had failed to notify us of a significant issue involving a person living in the home.

More positively, the provider now employed sufficient staff to meet people’s individual needs and preferences. Staff recruitment practice was safe.

Staff worked in a non-discriminatory way and supported people with kindness and care. Staff promoted people’s dignity, privacy and independence.

The provider worked collaboratively with local health and social care services to ensure people had access to support as required. Systems were in place to ensure effective infection prevention and control. People's medicines were managed safely.

People were provided with food and drink of their choice which met their nutritional requirements.

Staff worked together in a mutually supportive way and communicated effectively with a range of other organisations. Training and supervision systems were in place to provide staff with the knowledge and skills they required to meet people’s needs effectively.

Staff were aware of people’s rights under the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives, in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The registered manager continued to provide exceptionally candid, reflective leadership and was liked and respected by everyone connected to the home. Lines of internal communication and control were now more robust and there was organisational learning from significant incidents. The provider was committed to the continuous improvement of the service in the future.

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

We carried out an unannounced comprehensive inspection of this service on 13 November 2019. We found several continued breaches of legal requirements. The rating remained Inadequate and the service remained in Special Measures.

Following this inspection, the provider completed an action plan to show what they would do and by when to address the shortfalls we found.

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

Why we inspected:

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe, Effective, Caring and Well-led which contain those requirements.

The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection together with the rating from the previous comprehensive inspection for the key question Responsive, which was not looked at on this occasion.

As the service is no longer rated as Inadequate overall or in any of the key questions, the service is no longer in Special Measures.

Follow up:

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least Good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Qu’Appelle Care Home is registered to provide accommodation and support for up to 36 older people, including people living with dementia. There were 25 people living in the home on the first day of our inspection.

People’s experience of using this service:

The provider was still failing to provide people with consistently safe, effective, caring, responsive or well-led care.

The provider had failed to ensure sufficient staffing to care for people safely and to meet their needs in a timely way. Staff were using unsafe moving and handling techniques and the management of people’s medicines was not consistently safe.

The provider had failed to ensure all staff had the necessary support and supervision to care for people in a consistently safe and effective way. Infection prevention and control practice was not consistently safe.

Staff continued to use undignified, impersonal language to refer to people living in the home and did not support people in a consistently compassionate and person-centred way. The provider had failed to respect people’s right to privacy.

Care planning systems were not consistently effective and staff recruitment procedures required improvement. Systems of organisational governance were inadequate and the provider had failed to address all of the breaches of regulations identified at our last inspection.

In other areas, the provider was meeting people’s needs.

Staff worked collaboratively with local health and social care services to ensure people had support when required. People received food and drink of their choice and their nutritional needs were met.

Staff worked in a non-discriminatory way and promoted people’s independence. People felt safe living in the home and staff knew how to recognise and report any concerns to keep people safe from harm.

The provider upheld people’s rights under the Mental Capacity Act 2005 and supported people to have maximum choice and control of their lives, in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

The registered manager had a candid, open leadership style and was liked and respected by his team. The provider notified the Care Quality Commission (CQC) and other organisations of issues as required.

There was learning from significant incidents and any complaints were managed in line with the provider’s policy. People and their relatives were consulted on the running of 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 and update:

The last rating for this service was Inadequate (published 16 May 2019) and there were multiple breaches of regulations. The service was placed in Special Measures. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Qu’Appelle Care Home on our website at www.cqc.org.uk.

We took enforcement action against the provider, including the urgent imposition of additional conditions of registration and the issuing of three fixed penalty notices. Some enforcement action is ongoing. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

At this inspection, we found insufficient improvement had been made and the provider was still in breach of regulations. The service remains in Special Measures.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified five continuing breaches of regulations reflecting shortfalls in staffing, health and safety, respecting people’s dignity and privacy, training and organisational governance.

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

Follow up:

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

Qu’Appelle Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 36 people, including people living with dementia. There were 31 people living in the home on the first day of our inspection. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by CQC.

People’s experience of using the service:

• People were not receiving safe, effective, caring, responsive or well-led care.

• We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of shortfalls in organisational governance; a failure to appoint a person with the necessary skills and experience to manage the home; a failure to properly assess and mitigate risks to people's safety; a failure to ensure sufficient staffing to meet people’s needs and keep them safe; a failure to ensure people’s nutritional and hydration needs were properly met and monitored; a failure to ensure staff had the skills and knowledge to support people safely and effectively; a failure to obtain proper consent to care and treatment; a failure to consistently treat people with care and compassion and promote their privacy, dignity and respect; a failure to support people in a consistently person-centred way and to meet their needs for mental and physical stimulation and a failure to properly display the rating of our previous inspection of the home. We also found one breach of the Care Quality Commission (Registration) Regulations 2009 due to a failure to notify us of significant issues involving the people living in the home.

• In other areas, the registered provider was also failing to provide people with the service they were entitled to expect. The provider's approach to safeguarding was ineffective; there was no evidence of effective organisational learning; internal communication required improvement; complaints were not managed in a systematic way; staff morale was low and people's feedback on the running of the home was not listened to.

• In a small number of areas, the registered provider was meeting people's needs. End of life care was provided in close consultation with specialist agencies; people were supported to access to a range of local healthcare services; there were some links between the home and the local community and some refurbishment of the home had taken place since our last inspection. To their credit, staff at all levels were admirably candid in providing feedback on their experience of working in the home.

Rating at last inspection:

Good (Published August 2017)

Why we inspected:

This inspection was scheduled in response to concerns shared with CQC by the local authority safeguarding and contract monitoring teams following their recent visits to the home. At this inspection we found service quality had deteriorated sharply. As result, the rating of the home is now Inadequate and the home is therefore in ‘Special Measures’.

Enforcement:

We served a fixed penalty notice and imposed additional conditions on the provider's registration. Full information about the enforcement action we took can be found at the back of the full version of this report.

Follow up:

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

We inspected the home on 18 July 2017. The inspection was unannounced. There were 35 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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 last inspection in May 2015 we rated the home as Requires Improvement. On this inspection we were pleased to find that provider had addressed the areas for improvement we had identified and the rating is now Good.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for four people living in the home and was waiting for a further five applications to be assessed by the local authority. Staff had a clear understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager maintained a high profile within the home and had worked hard to address the areas for improvement identified at our last inspection. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home in the future. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

There was a warm, relaxed atmosphere and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality, that met their individual needs and preferences. A range of activities and events was organised to provide people with stimulation and occupation.

There were sufficient staff to meet people’s needs and staff worked together in a well coordinated and mutually supportive way. There was a varied training programme in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff were provided with regular supervision and shift handover meetings were used effectively to ensure staff were aware of any changes in people's needs.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

We inspected the home on 17 May 2016. The inspection was unannounced. There were 35 people living in the home on the day of our inspection.

The home had a registered manager (the ‘manager’) in post. A manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for 10 people living in the home which had been assessed and authorised by the local authority.

During our inspection we found a breach of the Care Quality Commission (Registration) Regulations 2009. This was because the provider had failed to notify us of significant incidents relating to the service. You can see what action we told the provider to take on this issue at the back of the full version of this report.

We also found other areas in which where improvement was needed to ensure people were provided with safe, effective care that met their needs. The provider’s approach to risk assessment was inconsistent, increasing the risk to people’s safety and welfare. Audit and quality monitoring systems were also not consistently effective.

In other areas the provider was meeting people’s needs effectively.

Staff knew how to recognise signs of potential abuse and how to report any concerns. Staff also had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

Staff worked closely with local healthcare services to ensure people had access to specialist support when this was required. People’s medicines were well-managed.

There was a warm and welcoming atmosphere in the home and a range of activities and events was on offer to provide people with stimulation and occupation. People were provided with food and drink of good quality.

Staff knew people as individuals and provided kind, person-centred care. There were sufficient staff to meet people’s care needs and staff worked together in a friendly and supportive way. The provider supported staff to undertake their core training requirements and encouraged staff to study for advanced qualifications.

The manager demonstrated an extremely open and responsive management style, providing a positive role model for other staff.

The provider conducted regular customer satisfaction surveys and the manager encouraged people to come directly to him with any concerns. Formal complaints were managed well.

Below is a summary of what we found when we inspected Qu’Appelle Residential Care Home on 14 May 2014.

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at people’s care records and other documentation.

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

During our inspection we focused on our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe.

Safeguarding procedures were in place and staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Recruitment practice was safe and thorough. Required checks had been carried out before staff commenced their employment.

Is the service effective?

People’s health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

We looked at people’s records which showed that care plans set out people’s individual care needs. They were current and the records showed they had been reviewed on a regular basis and adjustments made when a person’s care needs changed.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. One person we spoke with told us: “I have been here two years and it’s really wonderful. I know all the staff and they know me.”

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role. They were able to tell us how they would escalate any concerns raised.

People completed a range of activities in and outside the home on a regular basis. The home had its own minibus, which helped to keep people involved with their local community. There were good links with the local secondary school and pupils were involved in volunteering.

People who used the service, their relatives and friends completed an annual satisfaction survey. We spoke with the manager who told us any comments about how the service could be improved were actioned. However, we did not see any actions plans which supported this and have asked the provider to put these in place to monitor any trends or themes.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

Some of the people who lived in the home were not able to tell us their experiences. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff.

We spent 30 minutes over the lunch time period watching people having their lunch. We saw staff interacted well with people and at an appropriate pace. People were offered choices about what they would like to eat and the atmosphere in the dining room was relaxed. People told us they enjoyed the new three course menu that had been introduced.

We spoke with two relatives who were visiting the home. One told us, "I give them 100%. Any problems, I can talk to them." Another relative told us, "Both Mum and Dad have been very well looked after. Mum came for a short break but decided to stay."

We spoke with a GP who visiting the home. They told us, "The people receive good care, they are well looked after."