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Archived: Queens Court Requires improvement

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Reports


Inspection carried out on 22 June 2017

During an inspection looking at part of the service

This inspection took place on 22 June 2017 and was unannounced.

Queens Court is a care home with nursing that is based in Windsor, Berkshire. Queens Court is one of eight care home services the provider currently operates. The service is registered to provide residential and nursing care for up to 62 people. The service is for older adults, some of whom have dementia. At the time of our inspection, 46 people used the service. Queens Court provides care across three floors; two floors accommodate people for nursing care and one floor provides residential care.

The service must have a registered manager.

At the time of the inspection, there was no 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.

Our last inspection was conducted on 12 July, 13 July and 14 July 2016. The key question ‘Is the service safe?’ was rated as ‘requires improvement’ and the overall rating for the service was ‘requires improvement’.

The purpose of this inspection was to examine the safety of people’s medicines management. This inspection looked at only one key question; “Is the service safe?” The rating remains as 'requires improvement’ for this key question. The overall rating has not changed.

The management of medicines at Queens Court was not safe. Medicines were not ordered in time from the GP and the community pharmacy. Records regarding medicines were incomplete, missing or damaged so that accuracy of administration could not be established.

Medicines were stored in appropriate areas, but the storage rooms were frequently beyond the recommended maximum temperature. The service and management had not taken action to ensure medicines rooms were at an appropriate temperature.

Medicines errors were reported by staff. However, an accurate record was not always maintained and investigations were not robust. Learning from medicines incidents to prevent recurrence was not demonstrated.

Relatives told us they did not have enough information provided to them about people’s medicines. They told us they witnessed medicines being given but did not know what the medicines were for.

The disposal of medicines was not always appropriate. We found evidence that medicines were sometimes disposed of incorrectly. Records of medicines disposals and destruction were not robust and checks by management for controlled drugs were lacking.

Staff did receive training about medicines safety and administration. Staff also completed competency assessments to check they could safely deal with people’s medicines.

We found one breach 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.

Inspection carried out on 12 July 2016

During a routine inspection

Queens Court is a care home with nursing that is based in a residential area of Windsor, Berkshire. The location is registered to provide care and support for up to 62 people. Queens Court is located in a modern built, fit for purpose premises with three floors. The building is not owned by the provider and another company gives support to the provider regarding the premises.

At the time of the inspection, there was no 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. A new home manager commenced in post on 18 January 2016, but at the point of the inspection was not registered. The home manager was due for a ‘fit person interview’ on 19 July 2016 where our registration team would assess the application to be a registered manager.

On 2 November 2015 and 5 November 2015 we conducted a comprehensive inspection of Queens Court and found seven breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009. The service was rated ‘inadequate’ and placed into ‘special measures’. We took criminal and civil enforcement to ensure people’s safety and ensure improvement occurred at the service. We served two fixed penalty notices and two warning notices to the provider following the inspection. A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale. The provider was required to be compliant with the warning notices by 31 January 2016.

The provider paid the two fixed penalty notices which we served. This disposed of the offence of two breached regulations. On 19 February 2016, a focused responsive follow up inspection took place to assess compliance with the two warning notices we served. We found the service was compliant with the content of the warning notices. The rating for key question ‘safe’ was changed from inadequate to requires improvement.

When a service is is rated as inadequate and placed in ‘special measures’, we will inspect again within six months. This comprehensive inspection took place on 12 July 2016, 13 July 2016 and 14 July 2016. The purpose was to check what improvements were made and whether the ‘special measures’ framework continues or can be removed.

People felt they were safe at the service. We saw they were protected against abuse and neglect, and that where this was suspected it was reported and investigated. Building and environment risks were assessed, but coordination of the risk management was not achieved. This left some risks unattended to or inappropriately disregarded. We found this was a continued breach of the regulation.

Staff recruitment, retention and deployment had significantly improved. The service had established a nursing workforce, and although agency registered nurses were still contracted, the use was declining through further effort to fill job vacancies. We made a recommendation regarding staff recruitment and the use of agency staff.

Medicines safety had improved through the support of community pharmacists. We made a recommendation that the service continues to work with pharmacists to drive safety.

Staff training and supervision had improved. Staff were attending mandatory training and were meeting with their line managers to discuss their performance.

The service was not compliant with the Mental Capacity Act 2005. The service had applied for additional deprivation of liberty authorisations from the local authority and awaited the outcomes. Further effort was required to ensure that staff correctly completed request forms and met the conditions of the standard deprivation

Inspection carried out on 19 February 2016

During an inspection looking at part of the service

Queens Court is a care home with nursing that is based in a residential area of Windsor, Berkshire. The location is registered to provide care and support for up to 62 people. Queens Court is located in a modern built, fit for purpose premises with three floors. The building is not owned by the provider and another company gives support to the provider regarding the premises.

At the time of the inspection, there was no 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. A new home manager commenced in post on 18 January 2016, but at the point of the inspection had not registered.

The last inspection was conducted on 2 November 2015 and 5 November 2015. At that inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took both civil and criminal enforcement against the provider. We issued the provider two warning notices; one for safe care and treatment and one for staffing. We also issued the provider with two fixed penalty notices. This was a focused inspection to follow up the two warning notices from the prior inspection. This inspection looked at only one key question; “Is the service safe?”

After the last inspection, the provider established a series of steps to immediately ensure people’s welfare and safety. These included liaising with the local authority not to admit further people to Queen’s Court, submitting regular action plans to the local authority and providing senior staff input in the operation of the service. Further steps included temporarily increasing staffing numbers to ensure sufficient staff deployment and increasing training for staff to gain the knowledge, skills and competencies they needed to ensure safe care for people.

We found improvements had been made at Queens Court following the last inspection and further changes were planned. Not all aspects of the changes had succeeded but further time was required to implement them and ensure sustainability.

Risk assessments and care plans were fully moved from computer based entries to paper based records. This meant the review and rewriting of everyone’s care documentation. Steps had been taken to ensure better review of people’s planned care. During our inspection however, we found planned care was not always the care that people received.

We found changes in the safe management and handling of medicines. Documentation and control processes around medicines administration had been strengthened by the management. Support workers and registered nurses received training and competency assessments to ensure they safely delivered medicines to people.

Safe staffing deployment was reviewed. Some new care staff were recruited and had commenced in post, including a new home manager, but the vacancy rate of permanent registered nurses was still unsatisfactory. The provider demonstrated they used strategies to attract more registered nurses to work at Queens Court but despite three months since the last inspection, just one new registered nurse had started working at the service. Further effort is required to fill the vacant posts. In the meantime, the provider continued to deploy agency registered nurses.

Staff had the ability to attend and participate in comprehensive training topics since the last inspection. A larger proportion of staff had received training in important topics like safeguarding, moving and handling and infection control. Some staff were booked to attend training in the months following this inspection. Staff had commenced supervision sessions with management, but more staff needed to participate and regularity in supervision meetings was required.

Further improvement

Inspection carried out on 2 November 2015

During a routine inspection

Queens Court is a care home with nursing that is based in a residential area of Windsor, Berkshire. The location is registered to provide care and support for up to 62 people. Queens Court is located in a modern built, fit for purpose premises with three floors. The building is not owned by the provider and another company gives support to the provider regarding the premises.

At the time of the inspection, there was no registered manager. The last registered manager left their position in October 2014. 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. There had been no registered manager at Queens Court since the last inspection. A series of managers had been in charge of the service since then. The provider told us they were recruiting a new manager who would become the registered manager.

The last inspection was conducted on 13 October and 16 October 2014 under the 2010 Regulations. At the last inspection, we asked the provider to take action to make improvements to people’s care plans and risk assessments, staff personnel files and staff training and support. The provider sent us an action plan on 1 April 2015 setting out how they would take action to address the breaches in regulations. The current inspection occurred over two days on 2 November and 5 November 2015. We found that compliance had not been achieved by the provider with regards to the previously breached regulations. Further breaches are evident under the 2014 Regulations.

People’s feedback regarding Queens Court was mixed, but overwhelmingly critical. They told us that they felt there were too many agency staff working at the care home and this impacted on the quality of the care they received. They also told us that their social and emotional needs were not taken into consideration and there were too few activities, including outings. Several people told us they had provided feedback to staff and management, but often they felt this had not been listened to and no changes were evident as a result. Despite this, people told us about their favourite staff members and that staff were mainly kind and gentle. When we spoke with relatives and visitors they confirmed what people who live at the home told us.

A number of professionals who visited the care home or were involved because of people’s care arrangements expressed their concerns regarding the standard and quality of care at Queens Court. They also told us they were concerned about the lack of leadership, the high use of agency staff and the absence of social activities that people could take part in. Other agencies had increased their monitoring of the service and required the service to keep in regular contact so that people’s safety was not further compromised.

People were safeguarded from abuse and neglect at Queens Court. Staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider was reporting instances where this had occurred to the local authority.

Staff handling medicines had not received satisfactory training or competency assessment to support them with this role. Appropriate protocols were not in place for the administration of ‘as required’ medicines. The location had ordered and overstocked too many medications, leading to wastage.

There was an insufficient investment in staff training. Some staff had not received important training in topics like fire safety, mental capacity and moving and handling. This meant people were at risk of receiving care from staff that did not know how to provide safe and effective assistance. Staff had also not participated in regular reviews of their performance with supervisors. Areas for staff improvement had not b

Inspection carried out on 13 and 16 October 2014

During a routine inspection

We inspected the home on 13 and 16 October 2014. The inspection was unannounced.

Queens Court is a care home providing personal care and nursing care. The home is registered to provide care and support for up to 62 people. At the time of our inspection 61 people were using the service.

A registered manager was employed by this 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. However, during our first day of inspection we were informed the registered manager was leaving on 14 October 2014. A deputy manager, quality and compliance manager and area manager would oversee the home during the week. Another registered manager within the company would start on 20 October 2014 and oversee the home until recruitment for the new manager was successful.

We looked at the provider’s recruitment processes. It is the legal requirement for the provider to obtain satisfactory evidence of conduct in previous employment relating to health or social care, or children or vulnerable adults and ensure information specified in Schedule 3 of Regulation 21 was available. Not all of this information was available for review.

Not all of the staff were up to date with training. Staff had not completed recent training including moving and handling, safeguarding, health and safety, food hygiene, infection control and mental capacity. There was a risk of people being supported by staff who may not have up to date knowledge and skills. However, staff received support to understand and carry out their roles and responsibilities by supervisions and appraisals, team meetings and handovers, and daily communications with senior staff and the registered manager.

Although the provider worked to ensure there were enough staff to meet people’s needs, we received a mixture of views from people, relatives and staff. Staff did not always have time to spend with people and talk to them.

People were not always supported according to good practice, for example, on one of the floors during lunchtime staff were helping people to eat while standing rather than sitting with the person. However, we saw mealtime was a relaxed and enjoyable time for people. People were supported to choose food and to eat their meal without rushing them and staff treated people in a caring way. There was enough food and drink available for people.

People were supported to maintain their health and wellbeing. Staff were monitoring people’s health and wellbeing, and referred them to appropriate professionals when needed.

Throughout our inspection we saw examples of appropriate support that helped make the home a place where people felt included and consulted. People and their relatives were encouraged to plan their own care and support. We saw staff responded to people’s needs quickly and in a caring way. People and their families were involved in the planning of their care and were treated with dignity, privacy and respect.

We looked at how medicines were managed and people supported to take their medicines. Medicines were kept securely and senior staff had keys to access the medicines. People were supported appropriately to take their medicines and appropriate records were kept to make sure medicines management was safe.

People felt safe at Queens Court and relatives agreed with this, and they were protected from abuse. Staff knew how to identify if people were at risk of abuse and knew what to do to ensure they were protected. The registered manager was knowledgeable about Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA) and had taken the right action to ensure people’s rights and liberties were protected. However, we did not receive a notification for DoLS outcome on time and this was submitted to us when we informed the provider about it.

Systems were in place to identify, report and respond to incidents and accidents appropriately and action was taken to prevent these events from recurring. The registered manager assessed and monitored the quality of care. The home encouraged feedback from people and their relatives, which they used to make improvements to the service.

The provider did not take proper steps to ensure people were protected against the risks of receiving unsafe or inappropriate care or treatment. The provider did not operate effective recruitment process and selection procedures. People were at risk because staff did not always receive appropriate training to enable them to deliver care and treatment to people safely and to an appropriate standard. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

Inspection carried out on 12, 18 July 2013

During an inspection in response to concerns

We spoke with 15 people who use the service and eight relatives or friends who were visiting at the time of our inspection. People who use the service told us staff were considerate and understanding and always maintained their dignity, privacy and independence when providing care. One person said �They are very kind to me, I feel they really listen.� Another person said �The staff always ask me how I want things done and give me choices.� People said they were involved in making decisions about their care and had the opportunity to express choice and preference in relation to how support was provided.

Throughout our inspection we observed that staff were respectful, patient and kind to people in their care. There was a quiet, unhurried atmosphere in the home.

Staff were well trained and knowledgeable about people in their care. They felt well supported by management and felt they could have a say in how the home was run. The service had an effective quality assurance in place that sought the views of people who use the service.

Inspection carried out on 16 January 2013

During a routine inspection

We spoke with people who live at the home. One person told us they were pleased with the choice of activities at the home. They told us "nothing is too much trouble" for the staff. During our visit the local GP carried out a weekly visit. The GP told us the home had "very good staff" who "care compassionately" for the people who live in the home.

Care plans were specific to the individual person and detailed their personal and social care needs. We saw people had been involved in planning their care.

The staff rota had recently been changed at the home. Staff we spoke with said the new rota was an improvement as there were more staff on duty over the busy lunchtime period and there was an additional member of staff working in the afternoons. Some people who live at the home told us they felt staff were available when they needed them.

People we spoke with were aware of how to complain and who to complain to. None of the people we spoke with had any complaints at the time of our visit.

Inspection carried out on 26 May 2011

During a routine inspection

We carried out interviews with six people to ask them about the care received at Queen's Court; four of these were residents who were able to take part in an interview, and two were relatives of two other residents who were not able to participate themselves.

We asked how staff treated people who lived at Queen�s Court and the responses were all positive, and ranged from �Generally very good�, to �I get treated very well�. We also asked if staff were respectful to residents and relatives, and everyone agreed that this was the case. We were told that people�s privacy and dignity were protected, and that there were sufficient staff to help people in a timely way.

People said the arrangements for activities had improved, and there were also positive comments about the meals. There were many compliments received about the staff generally, and where individual staff were named, this was passed on to the management for their attention. Those residents we spoke to said they felt safe at this home, and none had any complaints, though people knew who they would speak to if they did.

When asked about the quality of the service at Queen�s Court, people told us it was �Very good� and most were able to give examples of where their feedback and opinions had been sought in order to improve the service further.

Reports under our old system of regulation (including those from before CQC was created)