Queens Lodge Nursing Home

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. The ones that applied to the area this home was located were commonly known as 'Tier Four Rules'. This meant the Covid-19 alert level was high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

There were good processes in place for putting on and taking off personal protective equipment (PPE) such as masks, gloves and aprons. Staff, management and visitors were using PPE correctly and there were robust procedures in place around the use of PPE.

Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

The provider and registered manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. People were also tested before admission and asked to isolate for a period of 14 days.

Where appropriate, and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions, these visits had been restricted and were only allowed in exceptional circumstances to support those at the end of their lives. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

We noted the provider and registered manager had developed a visiting area in a suitable location within the home. This incorporated shielding and isolation processes to ensure visitors and residents were protected. The registered manager said that this would only be used when guidance allowed and the current rules were relaxed.

Visiting rules and process were communicated effectively to people using the service and their relatives. We noted regular emails were sent to relatives. People were also supported in contacting their friends and relatives by the use of social media and video messaging services. This assisted in promoting people's mental wellbeing.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. Specific risk assessments could be used if people had characteristics or conditions which meant they were susceptible to serious illness.

Staff had received infection prevention and control training and were regularly supported to update their knowledge and skills in relation to best practice standards.There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Areas of the home could be segregated in the event of widespread infection so as to assist with appropriate isolation of people. The registered manager said separate staff members could be used to help in this situation.

Policies and infection control processes were regularly reviewed when guidance changed. The registered manager said this was an on-going process so that they kept up to date with developments and changes.

The home was clean and hygienic. The service had designated cleaning staff. All staff had received Covid-19 related supervision and the registered manager was proactive around ensuring staff had access to appropriate support to manage their wellbeing should it be required. We noted regular telephone contact with staff when they were isolating at their own home.

Further information is in the detailed findings below.

We last inspected this service in February 2016 when the service was rated as good.

This inspection was carried out on the 17 September 2018 and was unannounced.

At this inspection we found evidence that 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.

People told us they felt safe and staff were knowledgeable about safeguarding processes and when to report any concerns to the registered manager or local safeguarding authorities. Staff demonstrated a good understanding of people`s needs, likes, dislikes and preferences. Staff were knowledgeable about risk management and how to mitigate risks to keep people safe. People were supported by sufficient numbers of staff who responded in a timely manner to people when they required assistance.

People received effective care from a staff team who had been trained appropriately and who were supported by the provider and registered manager. Other specialist health care professionals worked with the management and staff to ensure the best possible care was delivered, and staff continually developed their skills. People's consent was obtained prior to care being provided and staff explained to people what they were consenting to. Where people were unable to provide consent, the legal requirements of the Mental Capacity Act 2005 (MCA) were understood by staff and followed.

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 support this practice.

The views of people using the service, relatives and staff were at the core of quality monitoring and assurance arrangements. The provider and registered manager learnt from concerns and incidents and used this information for continuous improvement. The provider and registered manager recognised the importance of staff being supported in their role from the beginning of their employment. Staff had regular supervision and opportunities to discuss concerns and express their views. Staff said they felt well supported by the management team and felt involved with the development of the service. Staff spoke highly of the management team and said they were able to discuss any issues.

People were supported to have sufficient food and drinks. People had access to healthcare professionals such as their GP as and when required.

People's medicines were managed safely and overseen by a registered nurse or a member of the management team. Senior staff administered medicines and had received training and confirmed they understood the importance of safe administration and management of medicines.

People felt that they were treated as individuals and that they mattered. The care people received was personalised and we saw staff paying close attention to the needs of the people they supported.

People were encouraged to socialise, pursue their hobbies and interests and try new things. There was an activities coordinator and she demonstrated a passion for improving the quality of life for people; she had innovative ideas on how to motivate and keep a person’s interest.

Care plans were comprehensive and captured people's support needs as well as their

preferences regarding the care they received. Care plans were updated every time a change occurred which influenced the way people received support. People were supported to take decisions about their care and be independent.

There was a record of people's end of life wishes to ensure their needs could be met at this time.

The manager and the provider carried out a regular programme of audits to assess the quality of the service, and we saw that these were comprehensive and capable of identifying shortfalls which needed to be addressed. Where shortfalls were identified, records demonstrated that these were acted upon promptly.

We last inspected this service in September 2013 when the service met all the regulations we looked at.

The service 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff we spoke with were aware of how to protect vulnerable people and had safeguarding policies and procedures to guide them, including the contact details of the local authority to report to.

Recruitment procedures were robust and ensured new staff should be safe to work with vulnerable adults.

There were systems in place to prevent the spread of infection. Staff were trained in infection control and provided with the necessary equipment and hand washing facilities to help protect their health and welfare.

We found the administration of medicines was safe and people thought they received their medicines on time.

People who used the service said food was good. People were given a nutritious diet and had choices in the food they were offered. We saw meals were unhurried and people chatted to each other socially.

Some staff had been trained in the Mental Capacity Act (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act (2005) and followed the correct procedures using independent professionals.

Electrical and gas appliances were serviced regularly. Each person had a personal emergency evacuation plan (PEEP) and there was a business plan for any unforeseen emergencies.

New staff received induction training to provide them with the skills to care for people. Staff files and the training matrix showed staff had undertaken sufficient training to meet the needs of people and they were supervised regularly to check their competence. Supervision sessions also gave staff the opportunity to discuss their work and ask for any training they felt necessary.

We observed there was a good interaction between staff and people who used the service. People told us staff were kind, knowledgeable and caring.

We saw that the quality of care plans gave staff sufficient information to look after people accommodated at the care home and were regularly reviewed. Plans of care contained people’s personal preferences so they could be treated as individuals.

There was a record of people's end of life wishes to ensure their needs could be met at this time.

There was a record kept of any complaints and we saw the manager took action to investigate and reach satisfactory outcomes for the concerns, incidents or accidents to reach satisfactory outcomes.

Staff, people who used the service and visitors all told us managers were approachable and supportive.

Staff meetings gave staff the opportunity to be involved in the running of the home and discuss their training needs.

The manager conducted sufficient audits to ensure the quality of the service provided was maintained or improved.

The environment was maintained at a good level and homely in character. There were several small areas for people to sit in peace or for small groups to play games.

Following the inspection visit we were sent an action plan informing us how the provider was going to improve the management of medicines within the home.

We revisited the service and found evidence that improvements had been made to the systems for the administration of medicines within the home. This meant people were safeguarded against the risk of the unsafe management of medication.

We spoke with three people who lived at Queens Lodge who told us they had no concerns about the support they received to take their prescribed medication.

We reviewed the care files of four people who lived at Queens Lodge. We found evidence that there were systems in place to record the decisions people were able to make for themselves. We found staff understood the need to seek consent from people before providing any care or treatment.

We saw that care plans clearly identified the needs of the person and included information on how they wished their care to be delivered. We found evidence that care plans included guidance for staff about the need to promote independence and choice for people in Queens Lodge wherever possible.

People we spoke with told us they received appropriate support with their medication. However we found improvements needed to be made to help make sure medicines are always administered safely.

We spoke with four members of staff who told us they felt well supported and confident in carrying out their responsibilities. We saw evidence that staff were appropriately qualified and provided with regular training opportunities.

We found that suitable arrangements were in place to manage an effective complaints process for identifying, receiving and handling complaints for people in Queens Lodge.