Queensmount Care Home

Queensmount Care Home is a residential care home providing personal and nursing care to up to 49 people. The service provides support to older adults. At the time of our inspection there were 47 people using the service.

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

People received exceptionally safe care from staff that had been empowered to speak up, address poor practice and promote equality and diversity. People told us they felt safe and trusted the staff team.

A person- centred approach had enabled positive risk taking which meant people’s rights and freedoms were being respected. Innovative, holistic therapies were trialled to manage risks associated with people’s mental wellbeing, new equipment was being introduced to reduce risks associated with skin damage and falls. Health and safety training had included mock scenarios of emergency situations to ensure staff understanding and competence.

People were supported by enough staff who had recruitment checks to ensure their suitability to work with older people.

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.

People were cared for by staff that had undertaken an induction and received on-going training and support that enabled them to carry out their roles effectively.

People had their eating and drinking needs understood and met. People had access to a range of healthcare services and were involved in decisions about their health and well- being.

Queensmount provided an environment that enabled people to maximise their independence and provided both social and private areas with accessible outdoor space. People were involved in decisions about the environment.

Staff demonstrated outstanding care and kindness and demonstrated a passion for enabling people to be the very best they could be. A culture of inclusiveness was embedded in the care provided and staff respected people’s individuality. People were involved in decisions about their care and had their dignity, privacy and independence respected.

People were supported to maintain friendships and enjoy past interests and hobbies. People’s relatives and the local community were an integral part of the home. Staff were passionate about enabling people to achieve their dreams and imaginative in making important events happen.

People received outstanding end of life care that provided thoughtful, kind, professional support to both the person and their loved ones.

The home was exceptionally well led with a culture that was positive, inclusive, enabling and achieved high standards of care for people. Management initiatives motivated staff and created a ‘can do’ culture.

Diversity was celebrated and ensured an inclusive approach to engaging with people and developing the service. Management collaboration with other agencies maximised opportunities for people to receive outstanding care. Outstanding practice had been shared within the organisation nationally.

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

Rating at last inspection

The last rating for this service was outstanding (published 8 June 2019).

Why we inspected

We undertook this inspection as part of a random selection of services which have had a recent Direct Monitoring Approach (DMA) assessment where no further action was needed to seek assurance about this decision and to identify learning about the DMA process.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Queensmount Care Home is purpose built and registered to provide accommodation and nursing or personal care for up to 49 older people. At the time of our inspection there were 45 people living at the home.

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

Care was personalised and there were sufficient numbers of staff to meet people’s needs.

Staff understood the signs and symptoms that may indicate a person is being harmed or abused and knew how to report this. They told us they would feel comfortable to whistle blow should they witness or hear about poor practice.

People were protected from risks because staff were familiar with how to care for people and minimise any risks that had been identified. Those who needed it were checked more frequently during the night and equipment had also been provided to keep people safe.

Staff understood what to do in the event of any emergency and were confident about the roles they would take. Staff also understood their role and responsibilities to protect people from abuse.

Staff understood the importance of infection control. The home was clean and well maintained throughout. Policies and staff practices were reflective of current best practice guidance. Staff had access to personal protective equipment and there was whole home testing in response to the coronavirus health risk.

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

Rating at last inspection

The last rating for this service was outstanding (published 8 June 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing levels, particularly at night, and the possible impact this could have on provision of care. Please see the safe section of this report. The overall rating for the service has not changed following this targeted inspection and remains outstanding.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service. If we receive any concerning information, we may inspect the service again.

People’s experience of using this service:

There was a very homely and welcoming atmosphere where people were supported by staff who were exceptionally kind and caring. Feedback about the compassionate and caring approach of staff was overwhelmingly positive. People were treated with dignity and respect in a way that truly valued them as individuals. The management and staff were always prepared to go the extra mile to ensure people received the care they needed and lived full and meaningful lives.

There was a person-centred culture that was driven by a motivated and committed staff team. They constantly looked for ways to improve the service and ensure people received the outstanding care they deserved. This motivation resulted in a whole team who were totally supportive and committed to providing high quality, individualised care. The staff team told us they were truly valued and respected. They were highly skilled, motivated and knowledgeable. They were also very well trained and supported and encouraged to progress and develop.

People were placed at the centre of the service and were genuinely consulted in relation to all decisions about their care and the service. Families and visitors were welcomed into Queensmount Care Home and were full of praise for the genuine warmth and kindness they experienced.

The service remained at the heart of the local community with strong community links with a whole host of different community groups regularly visiting and people accessing their community.

The service was exceptionally well-led. The registered manager demonstrated how their open and listening management style and robust quality assurance systems had sustained continual development and improvement at the service. They had demonstrated ways of working that ultimately improved the outcomes for people living at Queensmount Care Home. They were clear about their expectations relating to how the service should be provided and led by example.

Since the last inspection, they had made many positive changes and were driven to provide an outstanding service. They were supported by a staff and a senior team who were passionate and fully committed to delivering quality person-centred care to people. Staff were motivated by and proud of the service and morale was very high within the service.

The service met the characteristics of outstanding in all areas.

Rating at last inspection: GOOD (The date last report published was 8 September 2016).

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection. The service has improved and has now been rated Outstanding.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated Outstanding.

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

Queensmount is a purpose built care home and is registered to accommodate a maximum of 52 people who require either nursing or personal care. There were 43 people living there at the time of our inspection.

The home was led by 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.

All of the people living at the home and visitors told us that they felt safe and well cared for. We received only positive comments about Queensmount throughout our inspection. Staff in the home were also positive about the home and the service they provided. They told us they felt well supported by the management team that was in place.

People received their prescribed medicine when they needed it. However we found that the service did not always follow national guidelines and the provider's own policies and we have made a recommendation about this.

People received care and support that was person-centred and respectful. They were kept safe and protected from risks wherever possible. People’s needs were assessed and plans were in place to ensure that their needs were met. People’s choices and decisions were respected and staff enabled people to retain their independence.

There were appropriate numbers of staff on duty to meet people’s needs.

Staff received regular training and supervision and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience to help people with their care and support needs. However, one person lived with a specific health condition which meant that they could sometimes require specialised care from the nursing staff. All of the staff had completed training in this area but had not completed update training. This had been raised with the registered manager by a specialist nurse in April 2016. This meant that, although the person was receiving the care they required, it was not being provided in the most up to date way and was not in accordance with NICE guidelines. Following the inspection, the registered manager confirmed that they had booked training for all nursing staff. We recommend that the provider ensures that all staff receive training that is in accordance with national guidelines.

Observations and feedback from staff, relatives and professionals showed us that the home had an open and positive culture.

There were systems in place to monitor the safety and quality of the service. This included the use of audits and surveying the people who used the service and their representatives.

You can see what action we told the provider to take at the back of the full version of the report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Risk assessments had been carried out both with regard to people's care needs and to other aspects of the running of the home, such as the use of moving and handling equipment and checking of hot water temperatures. Those staff whom we spoke with were aware of people's needs and how to ensure they were met safely.

Staffing levels were satisfactory. We found that people's needs were being met. However, both staff and people living in the home told us that they felt staffing levels had decreased; staff were rushed and people were ringing call bells sooner than they actually needed as they were anticipating delayed responses.

CQC monitors the Deprivation of Liberty Safeguards which apply to care homes and nursing homes. The manager confirmed that they were aware of recent changes to the use of this legislation. Only 39 of the 85 Care workers had been trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards within the last 12 months. Of these, only 14 people had undertaken training since the changes to legislation. We identified applications should have been made for at least one of the people living in the home but had not been at the time of our inspection.

Is the service effective?

Where people did not have the capacity to consent, the provider did not act in accordance with legal requirements. Care records did not always contain evidence of people's consent to receive care and we also found relatives had given consent for care when they had no legal right to do so.

All of the people we met who lived in the home were clean, well kempt and comfortable. We saw from our observations and from speaking with staff that they understood people's needs, likes and dislikes and knew them well.

Is the service caring?

Throughout the inspection we observed that staff were kind and caring and in some instances were able to anticipate people's needs. People's privacy, dignity and preferences were respected. People living in the home told us staff were always kind and polite.

Is the service responsive?

We found that people's needs had been assessed before they moved into the home to enable staff to ensure that they had the required skills and equipment to meet their needs. Once admitted to the home, people's needs were regularly reviewed and any changes were responded to as necessary either by consultations with other health professionals, changes to the way their care was provided or provision of equipment. A local GP who was visiting a person living at the home at the time of our inspection, told us staff were very good at calling for help and always followed any instructions they were given.

Is the service well-led?

There were systems in place to monitor the quality of the service provided and to identify and manage any risks. Where issues had been identified, such as decreased levels of satisfaction in the resident's survey, actions had been put in place to improve matters. The provider took account of complaints and comments and records supported this. We also found evidence that learning took place from any incidents or accidents to try to prevent future reoccurrence.

This inspection was carried out to ensure that the service had made the necessary improvements to achieve compliance with the regulations.

We spoke with the manager, four care staff and two people who used the service. We looked at six care plans and four staff records. We found that systems had been reviewed and new documentation had been implemented. This meant that people's needs were fully assessed and planned for and that staff were recruited in a robust manner to ensure that people were cared for, or supported by, suitably qualified, skilled and experienced staff. We also found that the information gathered by the home to review the quality of it's service had been used more effectively.

During our inspection we saw that people were relaxed with staff and responded positively when staff spoke and spent time with them. There were different activities going on throughout the day to keep people occupied.

We spoke with six people, five staff, the acting manager and the organisation's regional manager. Comments from people about living at the home included; "They've done me proud. I can't thank them enough", and "I can't praise them enough. The food is good and the staff are always happy to help me".

There were sufficient staff on duty to meet people's needs.

We found shortfalls in the way people's care was assessed, monitored and delivered. People's needs were not fully assessed, and planned for. Care plans contained omissions or conflicting information. This placed people at risk of unsafe care.

We also found shortfalls in the recruitment of staff which meant that the home could not be sure people were suitable to work with vulnerable adults. The home's quality assurance systems were not being used effectively which meant they had not identified for themselves the issues that we found during this inspection.