Queensgate Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service remained in breach of legal regulations in relation to managing risks in the service and premises and equipment.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was promoting a positive culture of safety based on openness and honesty. An open-door policy was in place for staff to speak to the management team about any concerns. Staff appropriately responded to accidents and incidents, reported them accordingly and kept people’s relatives informed. A relative said, “[My relative] had a couple of falls and I was contacted immediately with appropriate action taken. They fell out of bed and now have a pressure mat by the side.”

The management team monitored and investigated accidents and incidents, sharing lessons learnt to embed good practice and reduced the risk of them happening again.

Systems in place had not always supported effective transfers of care or ensured referrals to healthcare professionals had been made in a timely manner. Staff told us admissions processes did not always ensure they received accurate information about people’s needs which meant at times they were unsure how best to support people.

The management team told us that since our last assessment, they had identified some referrals had not been made to other services in a timely way. This placed people at risk of not receiving appropriate care when they needed it. For example, where people had unintentionally lost weight, referrals had not always been made to the dietitian in a timely manner. The management team told us they had been working to address this issue and had taken appropriate action to ensure all required referrals had now been made. Care records we reviewed confirmed this.

Staff worked with people and relevant professionals to help keep people safe from harm and abuse. People and their relatives consistently told us people were safe and they trusted staff. One person said, “I have confidence that I will come to no harm here. The staff are helpful and will do their best to meet your needs.”

Staff had the skills and knowledge to identify safeguarding concerns and reported them internally. Staff were confident concerns would be acted upon by management and knew who to contact outside of the provider if they continued to have concerns. Records showed safeguarding concerns had been appropriately reported.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and whether proper legal authorisations were in place when needed to deprive a person of their liberty. Applications were appropriately made to deprive people of their liberty, with people’s care plans updated following authorisations and to reflect any associated conditions. Systems were in place to ensure DoLS were monitored and to ensure new authorisations were applied for in a timely manner.

Risks were not always appropriately assessed, monitored or managed. For example, everyone had a personal emergency evacuation plan (PEEPs) in place, available electronically. However, the fire file in the grab bag which would be used in an emergency was not up to date and contained PEEPs for people no longer living at the service. This placed people, staff and emergency personnel at risk in the event of a fire. Shortfalls were identified in PEEPs at the last assessment, and we found they had not been addressed.The management team had identified not all staff had taken part in fire drills and had started to address this to ensure all staff knew what to do in the event of a fire.

A heatwave plan was in place to help manage risks associated with hot weather. This included increased fluids and ice creams for people and staff. However, we found some shortfalls in temperature monitoring as it was not being completed in line with the provider’s protocol. This meant the heatwave plan could not be effectively monitored and hot weather risks remained, as we found the service to be very hot.

Staff understood how to keep people safe in line with their care plans which included positive risk taking of accessing the community and managing medicines independently where it was appropriate for some people. People were supported to mobilise and transfer safely. A relative said, “They always have two people to hoist [Person] and they do that very carefully, with reassurance given.”

The provider did not always ensure the environment promoted people’s wellbeing and safety. For example, outside areas were poorly maintained and the garden was not secure. This meant people could not access the garden freely and could only use it when staff were present which increased restrictions on people’s day to day life. Relatives said, “The conservatory door is never opened. It has a seating area outside at the front and it would be nice if they could create a secure area for people to sit there,” and, “The car park is uneven, and I know someone who has fallen on it.”

The provider had a maintenance programme in place to improve the environment and some areas had been improved. However, areas still needed to be addressed and some flooring which had been replaced had since been damaged. For example, a shower room needed renovating, some flooring and some furniture was damaged and needed replacing. A relative said, “I would say the building needs redecorating and sprucing up. The chairs and tables in the lounge look tired.” Redecorating of the service was underway and regular servicing of the premises and equipment was completed to help maintain people’s safety.

The management team ensured there were enough skilled and experienced staff. Staff had the skills and knowledge to support people. Staff completed a vast array of training which supported them in meeting people’s wide-ranging needs. Staff confirmed they received regular supervision and support from the management team with their roles.

Staffing levels were safe and supported staff to meet people’s needs in a timely manner though people told us at times they still had to wait. Staff were visible throughout the home, were able to spend quality time with people and responded promptly when people needed support. A relative said, “There is always a member of staff nearby if I need one.”

Systems were in place to ensure the safe recruitment of staff. Appropriate checks had been made to ensure staff were safe to work with vulnerable people, though greater scrutiny of gaps in staff employment history was required. Induction processes were in place to support new staff and members of the staff team were able to progress with their careers through development opportunities and support.

The service was clean and infection prevention and control (IPC) processes were followed. One person told us, “The place is kept nice and clean.” The provider assessed and managed the risk of infection through ensuring staff were trained in IPC, ensuring there was sufficient stock of personal protective equipment (PPE) and domestic staff were on site daily to promote the cleanliness of the service. Though some furniture and areas in the service needed updating to help maintain effective IPC.

The provider did not always have effective oversight of people’s medicines to ensure they were administered safely and as prescribed. Audits of people’s medicines and associated records had not been regularly completed which meant the provider was unable to identify and address shortfalls. For example, one person did not receive their antibiotics as prescribed as dates had been entered incorrectly onto the handwritten medicine record. Also, opened dates were not recorded on eye drops and 1 person’s eye drops were found to potentially be out of date which placed them at increased risk of eye infections and compromised their effectiveness.

Staff were trained in the safe administration of medicines, and their competency had been assessed in line with best practice. Staff engaged positively with people when administering their medicines. They sought people’s consent and respected their right to refuse. Where appropriate, systems were in place to support people to administer their own medicines.