Archived: Queens Oak Care Home

Queens Oak Care Home is a residential care home providing personal and nursing care to up to 89 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 67 people using the service.

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

People told us they were treated with kindness and care by staff. People knew how to complain and felt they were listened to, however we found examples of where issues had not been promptly addressed by the service. The service engaged with people and their family members considering their equality characteristics and kept people informed of changes to the service.

Some key areas of safety were not always effectively managed. Risks to people were assessed but sometimes risk management plans were not followed. We found examples of skin integrity issues not being fully addressed. Medicines were not always managed safely at the home.

The service had a new manager who recognised where improvements were needed. Quality and audit systems were in place but did not always fully identify areas which were not working well. People were safeguarded from abuse and improper treatment and there were suitable measures to protect people from infection risks, including those from Covid-19.

Staff spoke of being well supported by managers and were able to develop their skills. Staff were recruited in line with safer recruitment measures and the service had worked to recruit care workers and nurses from overseas and support them to obtain appropriate qualifications.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 30 December 2020).

Why we inspected

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

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

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 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 have found breaches in relation to safe care and treatment at this inspection.

Follow up

Following our inspection the provider informed us of their intention to close the service. We will request an action plan and meet with the provider to understand what they will do to improve the standards of quality and safety in the meantime. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service.

Queens Oak Care Home is a nursing home. It provides personal care and nursing care to older people and people living with dementia. At the time of our inspection there were 69 people living at the service.

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

People told us they felt safe living at the service. Staff received training in safeguarding adults and told us they felt their concerns would be taken seriously. Staffing levels were assessed based around people’s care needs and managers checked that staff were suitable for their roles. The provider maintained systems to assess risks to people and implemented plans to mitigate these. Medicines were managed safely with appropriate checks carried out by senior staff.

People were protected from infection control risks, including those from COVID-19. There were clear systems for visitors to follow and staff had access to protective personal equipment (PPE). Managers provided training for staff in its safe use and ensured staff used it correctly. Staff and residents had access to regular testing for COVID-19 and there was an enhanced cleaning routine in place to reduce the risk of cross-infection. Incidents were logged and investigated appropriately when necessary and there was a strong culture of learning from incidents, including those which had taken place in other services.

Staff received appropriate training and supervision to carry out their roles. Care workers told us they found training useful and had benefitted from online training since the pandemic began.

Residents and their relatives told us the management of the service engaged positively with them and kept them updated on what was happening in the service. Staff told us they felt well supported by their managers. There were clear lines of responsibility and a detailed audit system to ensure issues were detected promptly. The provider worked to ensure the service continued to learn and develop.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 1 June 2019).

At our last inspection we found breaches of the regulations in relation to staff not receiving appropriate training and supervision to support them in their roles. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

At this inspection we found the provider had made improvements and was no longer in breach of this regulation.

Why we inspected

On 30 October 2020 we carried out a monitoring call using our transitional approach to monitoring services. This focuses on safety, how effectively a service is led and how easily people can access the service. This call will help us to decide whether we need to take further regulatory action at this time, for example an inspection. Our monitoring indicated that there may be a higher level of risk at this service.

We were prompted to carry out this inspection in part due to a specific incident, following which a person using the service sustained a serious injury. This incident was subject to an investigation at the time of writing this report. As a result, this inspection did not examine the circumstances of the incident. However, the information CQC received about the incident indicated possible concerns about the management of behavioural risks and staffing levels. This focused inspection examined those risks.

We used the ratings from our last comprehensive inspection for the key questions not inspected this time to calculate the overall rating.

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

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

What happens next?

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

People's experience of using this service:

Since the last inspection, there has been a change of leadership within the home.

The provider took into account the needs of people living with dementia and sought guidance about the design and adaptation of the home environment.

Staff had completed dementia awareness training. However, training was behind schedule in other key subjects. Staff supervision and appraisal was not always taking place on a regular basis.

People were cared for in a way that respected their privacy and dignity and promoted their independence. We saw many examples of good care, with staff showing kindness and compassion towards the people they were caring for.

Complete and contemporaneous care records were in place for each person using the service. Care planning documentation and related records were treated confidentially and stored safely in line with the Data Protection Act.

People’s risk assessments provided clear guidance to staff as to how to manage risks associated with people’s care and support.

Staff understood how to recognise and respond to safeguarding concerns to keep people safe and supported people in the least restrictive way possible. This was kept under review by the management team.

Staff worked closely with healthcare professionals and made appropriate referrals when needed.

Staff were responsible for ensuring people had enough to eat and drink and provided appropriate support where this was required.

A lifestyle co-ordinator was in post and there were opportunities for people to participate in a range of activities within the home.

Staff were following safe infection prevention and control procedures.

Regular auditing ensured quality issues were identified and managed appropriately.

Complaints were investigated but records did not always document what action was taken when complaints concerned poor staff performance.

Rating at last inspection: Requires Improvement (report published October 2018)

Why we inspected: This inspection was part of a scheduled plan based on our last rating of the service and aimed to follow up on some concerns we found at our previous inspection in September 2018.

Enforcement: We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Please see the action we have told the provider to take at the end of the full version of the 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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Queens Oak Care Centre is an 89 bed purpose built care home set out over four floors. The service is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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. 82 people were residing at the home when we visited.

At our last inspection in August 2017, we made a recommendation in relation to the storage of confidential records. We rated the service ‘good’ overall.

On 17 August 2018, Lambeth Council informed us of their decision to formally suspend all new long and short-term placements at the home with immediate effect. This decision was made in response to concerns raised about the quality and safety of care being provided.

This inspection was brought forward due to concerns about the safety and stability of the service.

The service did not have a registered manager in post. A home manager had recently been appointed and told us she would be registering with the CQC to become the registered manager in due course. A registered manager is a person who has registered with the CQC 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.

CQC was not able to monitor the operation of the service effectively because the provider was not always notifying us of safeguarding concerns, incidents, accidents and events that prevent the service from running normally.

Staff were not always effectively deployed. People told us that staff did not always respond quickly to their requests for assistance. This meant people were left unsupervised for long periods and their care, treatment and support delayed unnecessarily. As a consequence, staff were not always supporting people to maintain their dignity.

Care plans contained some information about what was important to people and about how their needs should be met. However, this often lacked sufficient detail to implement responsive person-centred care.

Risk assessments did not always provide clear guidance to staff as to how to manage identified risks associated with people’s care and support.

Staff were not always following safe practice in regards to the administration and recording of people’s prescribed medicines. People were not always having their medicines reviewed in a timely manner.

Staff training was not well managed and systems were not in place to ensure all staff practiced in a safe and caring way.

Staff understood how to recognise and respond to safeguarding concerns to keep people safe. However not all staff were aware of how to raise a concern outside the organisation.

Staff were responsible for ensuring people had enough to eat and drink. However, we observed drinks being left out of reach and people being left with drinks in their hands with nowhere to place them. Snacks such as biscuits, cakes and fruit were available throughout the day for people to help themselves to. However, this may have meant staff were unable to monitor those with specific nutritional needs.

People told us there were not enough activities. Despite there being an activities coordinator in post, adequate steps had not been taken to ensure regular and meaningful activities were appropriately planned, organised and accessible.

People did not always experience meaningful and caring interactions with staff. This was needed to reduce the risks of social isolation and to enable people to feel involved in their care.

Complete and contemporaneous records were not always in place. Accident and incident records were incomplete and did not always evidence the action taken to prevent similar events happening again.

People’s sensitive information was not always being treated confidentially, carefully and in line with the Data Protection Act.

Staff were not always following good infection prevention and control procedures. We saw evidence of mice droppings despite the ongoing intervention of pest control services.

It was unclear whether complaints were being managed effectively as records were incomplete and outcomes of investigations were not clearly explained.

Managers completed a range of audits. However, these had not identified or addressed all of the shortfalls we found during our inspection.

The Care Quality Commission (CQC) is required 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 put 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 or others. At the time of the inspection, appropriate applications had been made to the local authority in relation to people who lived at the service.

Staff worked closely with healthcare professionals and made appropriate referrals when needed.

There were examples of good care, with staff showing affection and compassion towards people.

Staff gave positive feedback about the support, advice and guidance available to them.

We found breaches of the regulations relating to person centred care, dignity and respect, premises, complaints, staffing, and service governance. We issued a warning notice in relation to breaches of regulation 12 safe care and treatment. You can see the action we have told the registered provider to take at the end of this report.

This inspection took place on 3 and 11 August 2017 and was unannounced. Queen’s Oak Care Centre was previously inspected on 30 June 2015 and was rated ‘Good’ in each domain inspected.

Queen’s Oak Care Centre offers nursing and personal care for up to 89 older people. At the time of the inspection there were 77 people using the service. The premises are purpose built and wheelchair accessible.

The service has a 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.

We have made one recommendation which you can find in the full report, relating to management of confidential documents.

People did not always have their confidentiality maintained as records were not always stored securely.

People were protected against the risk of abuse as staff received on-going training in safeguarding and knew how to identify different types of abuse and appropriately escalate their concerns. Staff were aware of the whistleblowing policy.

The service deployed sufficient numbers of suitably vetted staff to meet people’s needs safely. Records confirmed robust pre-employment checks were carried out to check staff’s suitability.

People received their medicines safely and in line with good practice. Systems and processes in place ensured medicines were stored, recorded and disposed of safely.

The service provided staff with comprehensive training programmes to effectively meet people’s needs. The induction programme provided by the service ensured staff were competent in carrying out their roles and responsibilities in line with the provider’s expectations. Staff continually reflected on their working practice through regular supervisions and annual training.

People were supported to access healthcare professional services as and when required and staff followed guidance provided. People had access to food and drink that reflected their preferences and nutritional needs.

People were encouraged to maintain relationships with people that were important to them. The service welcomed friends and visitors with no restrictions. People’s views of the service were sought and consent to care and treatment given, prior to care being delivered. People had their privacy respected and their dignity maintained. The service encouraged equality and diversity to ensure people were able to express their views and live the way they chose.

Care delivered was personalised and responsive to their needs. Care plans were comprehensive and regularly reviewed and updated to reflect changes to people’s needs. Where possible people were encouraged to participate and lead the development of their care plans.

The service had a complaints process that actively encouraged people to share their views and complaints. Records showed complaints were investigated with healthcare professionals input sought where appropriate.

People were supported in a service that was transparent and inclusive for all. People spoke highly of the registered manager and told us they found her approachable, fair and interested in both people and staff’s views.

The registered manager carried out audits of the service to improve quality, audits looked at care plans, risk assessments, medicines, maintenance and staff. Quality assurance questionnaires were sent to people and their relatives to gather feedback.

The registered manager actively sought partnership working to drive improvements. Healthcare professionals told us the registered manager took on board guidance and support and implemented this into the delivery of care provided.

We saw people who were at risk of falling being assisted by staff to move between rooms in a manner that gave them security and confidence.

A relative present told of the distress their parent experienced on occasions prior to coming to the home due to advancing dementia. They said 'staff know how to care for people properly and reassure people with dementia, my mother is contented and settled in the home."

We saw a file of thanks and compliments about Queens Oak; one described the service as 'top notch.'

A member of staff said that they wanted to do a good job to help people living at Queens Oak 'you just imagine if it was your Mum or Dad, you would want the best for them, so we want the best for our people too.'

The service was effectively led, and this ensured a competent skilled staff team was present to provide the consistency of care people needed.

Inspection (SOFI). We also gathered evidence of people's experiences of the service by speaking with 7 relatives, and stakeholders.

The feedback received from people living at Queens Oak and from visiting relatives was positive. Visitors described their confidence in the expertise demonstrated by staff in the way they cared for people with dementia. One person said " I am now able to be part of my partner's life since they they moved to this home, I understand from staff the importance of touch and sound in a person's life when they can no longer speak".

Staff received specialist training that enabled them respond appropriately to the needs of the people they cared for. Staffing levels enabled people using the service experience a positive sense of wellbeing. One person said "There is always someone nearby to help me, the support I get is at a pace that suits me, I am slow with my movements but staff are patient and never rush the tasks".

Activity programmes were varied and acknowledged individual capacities and abilities, they were tailored to individual needs and offered people appropriate stimulation.