Archived: Queens Road Care Home

The service provides care and accommodation for up to seven people with learning disabilities. At the time of our inspection there were six people living at the home.

There was a registered manager in place at the 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.

People’s rights were mostly protected in line with the Mental Capacity Act 2005 (MCA), however we did find occasions where the best interests decision making process had not been followed as it should. We also saw that for some decisions, staff were unable to find records of decisions that they said they had made using the MCA. This was an area of the service that required improvement.

Since our last inspection, the registered manager had made improvements to the outside environment; however further work was required to make sure it was fully suited to the needs of people in the home. The registered manager told us they had addressed this with the organisation.

We found that people received good care at the home and their needs were met by staff who were well trained and supported. Staff told us they had received the training they needed to meet people’s complex health needs. Staff confirmed they received regular supervision as an opportunity to discuss their performance and development needs.

Staff supported people in a kind and caring manner and were respectful in their communication. Staff used visual prompts to help people make choices. People were involved in giving their views and opinions about how the service should develop.

People using the service were safe because there were sufficient staff on duty to meet their needs. Staff had been trained in safeguarding vulnerable adults and were confident about reporting any concerns.

The service was responsive to people’s needs. People had clear support plans in place to describe how people should be supported. These were person centred in nature. Staff were knowledgeable about the people they supported and there was a keyworker system in place. This provided opportunity for people to build strong relationships with staff.

There was a system in place to respond to complaints. Any learning points from complaints were addressed with staff.

The home was well led. Staff were positive about the support they received and told us communication was good. Team meetings and shift handovers took place as a means of ensuring staff were aware of important information and developments in the service.

There were systems in place to monitor the quality and safety of the service provided. In the last 18 months, the provider had recognised that improvements to the service were required and an action plan had been devised. We saw that progress with the action plan was being made.

Queens Road Care Home provides personal care and accommodation for up to seven people. People at the home had learning disabilities. At the time of our inspection there were six people living at the home.

A registered manager was in post at the time of our inspection. 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.

The home was not always safe as the external environment was poorly maintained. This meant it was not always accessible to people and posed potential hazards. Improvements had been made since our last inspection in July 2015 in the way medicines were stored and organised. Medicines were administered by staff who were trained and assessed for competency. However, clear guidance was not always in place for when ‘as needed’ medicines may be required. Staff could not always locate key guidance on how to manage people’s health conditions safely. Safe recruitment procedures had not always been adhered to.

The home was not always well led as policies and assessments were not always up to date. Care records were not always clearly organised so staff could access the information they needed. The home had undergone a number of changes in the senior management team. The home was now ensuring that the senior team in place could make the improvements they had identified. Staff spoke positively about the changes that had occurred to make improvements. The staff team said they were involved in the home through meetings and were supported in their role. Steps were being taken to promote a positive culture and good practice through team building days. Notifications were sent to the Commission as required. Systems were in place to monitor the quality of care.

Staff understood the principles of the Mental Capacity Act 2005 and applied these in their role. Best interest decisions, when needed, were made in accordance with guidelines and with involvement from relevant people. Applications were made when appropriate in relation to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to treatment or care or need protecting from harm.

Staff had an effective induction process. On going training ensured staff were skilled and knowledgeable. Staff spoke positively about the training provided. Training specific to the needs of people living at the home was arranged. Regular supervision supported staff in their role.

Family and friends could visit the home whenever they wished and commented that staff were welcoming. We observed staff having a kind and caring approach to people. Staff knew people well and the things that were important to them. Staff supported people’s religious needs and personal preferences.

Care records were person centred. They showed how people wished to be supported. Activities of people’s choice were offered within the home and the local community. Activities were being developed so people had more opportunities available to them. People could give feedback about the home through meetings and surveys.

During this inspection we looked at the arrangements being made for recording information about people's care and support. This helped us to answer the question 'Is the service effective?'

At our previous inspection in April 2014, we found that accurate records were not always maintained, particularly in relation to supporting people who used a PEG (Percutaneous Endoscopic Gastrostomy). There were also inconsistencies in the way staff were recording how support plans and risk assessments had been reviewed. Monthly summaries were not always completed.

We returned to the service in September 2014 and found improvements had been made. Care documentation had all been reviewed and updated where necessary. New template recording forms had been implemented in relation to the care of people who used a PEG. However these were not yet being used consistently to record all the necessary information.

Below is a summary of what we found. This is based on our visit to the home when we met with the people who used the service and with members of the staff and management team. Not everybody who used the service was able to express their views verbally and our observations in the home helped us to make judgements about the support that people received.

Please read the full report if you want to see the evidence supporting our summary.

Is the service safe?

Not everyone who lived in the home was able to communicate with us verbally. However, we made observations that suggested people were settled and content in the presence of staff. Staff were respectful and aware of their responsibility to safeguard people who used the service.

Risk assessments were used to identify the safest ways of supporting people and these were reviewed regularly. Information about incidents and accidents was recorded and this showed the actions that had been taken to address any risks, such as seeking the support of other professionals.

Staff were supported to meet the needs of people in the home, through training specific to individual needs, such as the management of epilepsy and supporting people with percutaneous endoscopic gastronomy (PEG) feeding.

We did find some shortcomings in the recording of information about people's care. For example, information about the amount of fluids a person had received, was not always recorded in the way that was identified in their support plan. This meant there was a risk that important information would not be shared between staff.

Is the service effective?

We saw that the individual needs of people using the service were met because staff were familiar with their support plans. We saw examples of people receiving support in line with the information recorded about them.

We saw records, which provided good evidence that the service worked well with other health and social care professionals to ensure that an individual's full range of needs were met. This included supporting people to access regular health checks with their GP, dentist and optician.

The information held about people was reviewed regularly by the person's keyworker and this gave opportunity to identify issues or changes that needed to be made. It was the expectation that people's support would be reviewed and reported on, on a monthly basis. However, we noted that frequently, monthly reports were not completed within the service's expected timescales

Is the service caring?

We observed positive relationships between people who used the service and staff. Staff provided support and encouragement in an appropriate manner and were respectful towards people who lived in the home. For example, we observed staff providing gentle encouragement to an individual with a visual impairment, to help them return to their room safely.

Support plans that we viewed were person centred and took account of people's individual needs and preferences. Opportunities were provided for people to take part in activities that they enjoyed and people's independence was promoted where appropriate.

Is the service responsive?

Staff were proactive in seeking support from other healthcare professionals when necessary. For example, the GP was contacted when it appeared that an individual may be ill. Referrals were also made to other services such as dieticians and speech and language therapy.

Is the service well-led?

There were systems in place to monitor the quality and safety of the service. This included monthly visits from another service manager to look at specific areas of the home. An audit was completed on a yearly basis and this looked at the 'essential standard of quality and safety'. This provided opportunity to identify shortcomings and take action to address them.

People who used the service had opportunity to raise any issues or complaints and could be assured that these would be listened to and acted upon. The regularity of service user meetings had lapsed in recent months, however, we were told that these would be reinstated on a monthly basis.

As part of this planned inspection we followed up minor concerns that had been found in November 2012. The provider had demonstrated compliance by ensuring that the care had been kept under review and that health appointments had been attended.

People were encouraged to be involved in making decisions. Where people lacked capacity this was done within the legal framework and in the person's best interest.

People we spoke with told us they liked living in Queen Road and told us about the activities that were regularly taking place.

Staff we spoke with demonstrated that they had a good understanding of the people they were supporting. Staff confirmed they had received sufficient training based on the care needs of the people living in the home.

Effective systems were in place to monitor and improve the quality of the service being provided. This included seeking the views of the people that were living in the home through care reviews and regular meetings.

The staff we spoke with demonstrated that they had a good knowledge of people's needs and how they liked to be supported.

Some people at the home were unable to make complicated decisions as they had been assessed as not having capacity to make these decisions. We saw that these decisions had been made in people's best interests in line with the Mental Capacity Act 2005(MCA).

We saw that medicines were safely administered. All staff who gave medicines to people had received training and had their competency assessed by senior staff.

We saw that staffing had been increased at the home as two people had recently moved into the home.

Staff we spoke with told us they were concerned by the amount of bank staff being used to fill shifts at the home. We spoke with the registered manager, who explained the arrangements that they had in place to recruit new staff.

People we spoke with told us that they knew how to make a complaint. Two people we spoke with told us that they didn't have any complaints to make and were well looked after by staff at the home.