Archived: Quintaville

This unannounced inspection took place on the 15 February 2017, and was carried out by one adult social care inspector.

Quintaville was previously inspected in October 2016, where we had identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Although staff had a good understanding of Mental Capacity Act 2005 (MCA), people records did not reflect this. We also found some areas of the home were not hygienic and were in need of refurbishment. Following the inspection of October 2016, the provider wrote to tell us what they would do to meet legal requirements in relation to the breaches we had identified.

We undertook this focused inspection on 15 February 2017, to check that the registered manager had followed their action plan and to confirm they now met legal requirements. On this inspection, we found improvements had been made and the provider was now meeting legal requirements. We have revised our rating to good for the key question of effective. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Quintaville on our website at www.cqc.org.uk.

The home had 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.

At our previous inspection in October 2016, we found some areas of the home were not clean and were in need of refurbishment. At this inspection, we found improvements had been made. The registered manager had introduced hygiene checks, which staff carried out four times a day; this helped to ensure that people bedrooms, bathrooms and communal area of the home remained clean and tidy. Where we had previously identified areas of concern we saw action had been taken. For instance the person’s ensuite bathroom, which had previously been identified as unhygienic, had been completely refurbished.

During our previous inspection, we found that although the registered manager and staff showed a good understanding of the Mental Capacity Act 2005 (MCA). People’s records did not reflect this for instance, where decisions had been made in people’s best interests these were not always being recorded. At this inspection, the registered manager confirmed that staff had received additional training and people’s records now contained mental capacity assessments and best interests decisions.

People said they felt safe and happy living at Quintaville. People looked well cared for, and we saw people were happy to be in the company of staff. Staff who had worked at the home for a number of years were knowledgeable about people’s needs and wishes and had the skills to support them. Records showed staff had undertaken an induction and received training in a variety of topics. These included safeguarding, mental capacity, first aid, pressure area care, moving handling, and food hygiene.

People told us they enjoyed the meals provided by the home. People were able to have their meals in the dining room, the lounge or in their own rooms if they wished. Where people required a soft or pureed diet, this was provided. Each food item was processed individually to enable people to continue to enjoy the separate flavours of their meals. We heard staff offering people choices during meal times and tea, coffee, and soft drinks were freely available.

People had access to a range of health care services and had regular contact with dentists, opticians, chiropodists, district nurses and GPs. Care records showed staff responded quickly to people’s needs.

This inspection took place on the 13 & 14 October 2016, the first day of our inspection was unannounced. This inspection was carried out by one adult social care inspector. Quintaville was previously inspected in July 2013, when it was found to be compliant with the regulations relevant at that time.

The registered provider is also the 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.

Everyone living at Quintaville was able to make simple, day-to-day decisions for themselves. However, some people did not have mental capacity to make complex decisions about their health and welfare. Where this was the case, people’s records did not contain capacity assessments. Where decisions had been made in people’s best interests we found these were not being recorded. Some people were having their freedom restricted for safety reasons. Applications to ensure actions taken were lawful had not been made, as they should be. We raised this with the registered manager who agreed that people’s records did not contain sufficient information to demonstrate the home was working within the principals of the Act. The registered manager assured us they would take immediate action to address this.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. MCA is a law that protects and supports people who do not have ability to make their own decisions and to ensure decisions are made in their 'best interests' it also ensures unlawful restrictions are not placed on people in care homes and hospitals. We checked whether the home was working within the principles of the MCA and found the home was not taking appropriate action to protect people's rights. We found that people were potentially being unlawfully deprived of their liberty, due to the home having locked doors, which meant people were not free to leave on their own. Staff told us that people living at the home would be at risk if they left the home unsupervised. We found no evidence that people’s capacity had been assessed to consent to these arrangements.

Not all areas of the home were clean and some were in need of refurbishment. For instance there was a strong persistent odour in two of the bedrooms we visited and they were in need of redecoration. One person’s ensuite bathroom was not hygienic and needed refurbishment. The registered manager carried out a range of health and safety checks on a weekly, monthly, and quarterly basis to ensure that any risks were minimised. For example, fire alarms, fire doors, emergency lighting, equipment and infection control.

People said they felt safe, happy and cared for at Quintaville. People looked well cared for, and we saw people were happy to be in the company of staff. Their comments included "I do feel safe", "the staff are kind" and “I'm happy here." Relatives told us the registered manager made sure people were safe and well looked after.

People were protected from abuse and harm. Staff received training in safeguarding vulnerable adults and demonstrated a good understanding of how to keep people safe. Staff said they felt comfortable raising concerns and were confident these would be dealt with. Recruitment procedures were robust and records demonstrated the home had carried out checks to help ensure staff employed were suitable to work with vulnerable people.

People told us they were happy living at Quintaville, staff treated people with respect and maintained their dignity. Throughout our inspection there was a relaxed and friendly atmosphere within the home. Staff spoke affectionately about people with kindness and compassion. People and relatives told us they were involved in identifying their needs and developing the care provided. People's care plans were informative, detailed and designed to help ensure people received personalised care. Care plans were reviewed regularly and updated as people's needs and wishes changed. People were supported to follow their interests and take part in social activities. Records showed that people were supported and encouraged to go shopping, out for coffee and to the local cinema on a regular basis.

People received their prescribed medicines on time, in a safe way. There was a safe system in place to monitor the receipt and stock of medicines held by the home. Medicines were disposed of safely when they were no longer required. Staff had received training in the safe administration of medicines. Risks to people's health and safety had been assessed and regularly reviewed. Each person had detailed risk assessments, which covered a range of issues in relation to their needs. Each person had a personal emergency evacuation plan (PEEP) and the provider had contingency plans to ensure people were kept safe in the event of a fire or other emergency.

People who were able told us they enjoyed the meals provided by the home. Comments included, “the food is good”, “It’s very nice.” One person said “if you want something different all you have to do is ask.” A relative said, “Meals I have seen always look appetising.” People were freely able to help themselves to snacks and drinks when they wanted, and we saw people who were not able, being offered snacks and drinks throughout the day.

People, relatives, and staff spoke highly of the registered manager and told us the home was well managed. Staff described a culture of openness and transparency where people, relatives and staff, were able to provide feedback, raise concerns, and were confident they would be taken seriously.

The home had notified the Care Quality Commission of all significant events which had occurred in line with their legal responsibilities. Records were stored securely, well organised, clear, and up to date.

We found two breaches 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.

This inspection followed up on this to see the changes that had been made. Quintaville was an older building over several floors that presented challenges to maintaining standards of cleanliness. However we saw that improvements had been made.

We saw new cleaning schedules had been implemented for the home. The workflow for laundry had improved to reduce the risk of cross infection from potentially contaminated linen or clothing. We saw that paper hand towels and soap dispensers had been fitted in bathrooms and toilets. Areas needing additional cleaning on the last inspection had been improved.

We saw that new equipment had been provided to replace older items that were difficult to keep clean, for example commodes. Older chairs had been replaced and we saw that one room had been fitted with new flooring. This had improved the environment for the person living there.

We found that the systems for auditing and reducing risks of the spread of infections were improved.

One person we speak to told us the home was "home from home" and that they felt very comfortable there.

We found people's care needs were being assessed and they were well cared for. Care workers had developed skills in communicating with people and attention was paid to personal grooming and dignity. We found some areas of the care plans needed strengthening with regard to the management of challenging behaviour. People were asked their views about the home and were able to make suggestions to improve the services they received. People's independence was encouraged.

We found people ate and drank well in accordance with their wishes. One person said 'the food is lovely. I only have to ask and I can have a cup of tea whenever I want. I feel like the Queen.'

We found that systems for making complaints were in place although none had been received for some time.

However we found some areas of the home were not clean enough to ensure that people were protected from the risks of cross infection. Many of these were remedied immediately following our inspection.

We found people varied considerably in their needs and abilities. Staff we spoke with told us that they knew people very well. One told us "It's not like a large place where there are 50 people to be looked after. Here we know everyone individually and can look after them and give them the time they need". Another told us that the people "were like family" to them.

People living at the home we spoke with told us they were looked after very well. One said "I am very happy here - it is my home and they know just what I need to make me happy and well". Another person nodded their head and smiled when we asked them if they were well looked after.

We saw clear evidence of the involvement of external healthcare and community support services. We saw that people had opportunities to participate in activities of their choosing. We saw that people went out regularly for outings. Photographs of these were on display within the home and for reference. We saw that people were consulted about what they wanted to do, and about how they wanted their care to be delivered.

A visiting consultant told us about how well a person at the service had improved since their admission.

We saw that some radiators still needed covering or risk assessments to be in place. We identified some minor maintenance or cleaning issues.