Archived: Quenby Rest Home

Updated 8 September 2025

Date of Assessment: 15 September 2025 to 21 October 2025. Quenby Rest Home is a residential care home providing support to older people, including those living with dementia and long-term conditions such as Parkinson's Disease. The service can support up to 26 people. At the time of our assessment there were 14 people using the service.

We completed this assessment in response to concerns about the service identified at our last assessment, in March 2025 and to check for improvement. We looked at all quality statements in the key questions of safe, effective, caring, responsive and well-led. We found continued breaches of the legal regulations in relation to safe care and treatment, person centred care, staff deployment, training and recruitment, governance and oversight of the service. The provider failed to demonstrate understanding of the widespread nature and seriousness of concerns identified and failed to prioritise highest risk within shortest time as reasonably possible. Our concerns were heightened during this assessment in relation to risk and fire safety and so the Commission took urgent enforcement action to mitigate risk and improve fire safety at the service.

Since the last assessment the provider had sought guidance and support from an external consultancy, and appointed, a new home manager, care manager and a care director to supervise the management of the service on their behalf. However, roles and responsibilities within the management team were unclear and the providers’ approach continued to be reactive and not pro-active in driving sustained improvement. They did not have an overall development plan, to plan for and drive improvement as well as inform the new management and consultancy of the direction of the service and what was expected of them. The service continued to put people's safety and welfare at risk. There was not a culture of learning. Lessons had not been learned and used to improve the service and limit risks to people.

Safeguarding concerns, incidents and accidents were still not being used as an opportunity to learn from, put things right and manage/minimise risks. There was a continued lack of personalised care for people living at the service. Improvements were needed in staff understanding of dementia care to enable them to support people and deliver care that was effective, and person centred. Governance systems were ineffective and needed further development to provide an accurate overview of the service. Whilst some audits had been introduced there was a lack of review and evaluation to complete the quality assurance cycle and inform the direction of the quality and safety of the service.

Staff were seen to have some positive interactions with people and spoke about them in a kind and caring way. However, people’s individual needs and preferences were not well understood. Staff did not have sufficient guidance to respond to people’s immediate care needs and reduce the risk of avoidable distress and discomfort. People’s dignity and independence was compromised by insufficient staff deployment, support, direction and training. People were not always, or had limited involvement in care planning, including information on their life histories, pastimes, interests and hobbies. Staff demonstrated a lack of understanding or competence in how to effectively communicate, interact, engage with or support people living with dementia.

Recruitment practices and induction of new staff were not robustly carried out to ensure the right staff were employed with the knowledge, skills and experience required for their role. The provider had made improvement in relation to redecoration to the premises and infection control. However, further work was needed to maintain the premises to a good standard and ensure a safe enabling environment to meet the needs of people living with dementia.

In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded. This service remains in special measures. The purpose of special measures is to ensure that services providing inadequate care make significant improvements. Special measures provide a framework within which we user our enforcement powers in response to inadequate care and provide a timeframe within which providers must improve the quality of the care they provide.

Updated 8 September 2025

Whilst some people we spoke with were happy, our assessment found elements of care that did not meet the expected standards. We used the short observational framework for inspection (SOFI) to assess care where people could not tell us about their experience. We also received mixed feedback from relatives with both positive and negative comments. These reflected a lack of personalised care and stimulation which placed some people at risk of social isolation, low mood, boredom and frustration. One relative told us, “There used to be a lot more activities which [Person] enjoyed, there are only really events occasionally now. These are good but [Person] does get bored.” Another relative said, “Sometimes they put [Person] in a chair where [Person] can’t see the television, I have asked them to watch out for that and have also requested for people to be enabled to watch things like Wimbledon or snooker if they want to. Rather than just having loud music on most of the time.” Another relative said, “The loss of activities has been a blow to [Person] and [Person] has become very bored. We are worried [Person] will slide back into feeling cut off from life.”

Many relatives commented on how the loss of gardening had affected their family member. One relative told us this had resulted in their family member losing interest. Another relative said, “They have organised some events since there are less activities, but if it is in the garden for instance, it’s one out then they are all out.”

Relatives gave positive feedback about the staff but remained concerned there were not always enough of them to meet people’s needs. Relatives acknowledged improvement in the fabric of the building. One relative said, “The place is very tired and could do with a freshen up, but this has started to happen now.” They also said easier access to the garden and some paving to access the raised garden beds would be helpful. Another relative told us, “[Person’s] room has been decorated to [Person’s] choice.” Another said it was good to see some maintenance going on. Another relative commented, “They [Provider] need to remember that for most, this will be their last Home. Let’s make it a Home.”