Archived: Quenby Rest Home

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question Good. At this assessment the rating has changed to inadequate. This meant people were not treated with compassion and there were breaches of dignity; staff caring attitudes had significant shortfalls.

This service scored 40 (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 did not promote a culture which demonstrated they treated people with kindness, empathy and compassion, or respect their privacy and dignity. Although staff were kind and compassionate, people’s care was being delivered intuitively and not driven by best practice.

Leaders and staff did not demonstrate they had a good understanding of what good care looked like. We received mixed feedback from relatives about how well staff knew their family members to understand their needs, strengths and abilities to achieve best possible outcomes. One relative told us, “Staff have recently started to ask about [Person’s] history, so they have topics to talk about with them.” However, care plans lacked information about people’s personal histories to help staff support them to maintain their identity and self-esteem. This meant care was not consistently personalised, including choice and participation in leisure activities to enhance their overall well-being and establish a sense of continuity in their life.

People’s dignity was not always respected. For example, on arrival at the service on our second site visit at 6am, we saw a cushion in an armchair in the bottom lounge was stained and wet with urine. Staff sat a person in this chair. Although we pointed out to staff the cushion was wet, we saw the person remained seated in this chair throughout the day in the urine.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Relatives told us, from their experience people were treated as individuals. A relative commented, “The carers seem nice, pleasant, kind and caring towards residents and know them and the visitors by name.” People’s care plans had considered some aspects of protected characteristics, such as cultural and religious needs. However, relatives told us, people’s sensory and communication needs were not consistently met to help them engage in their care, treatment and support to maximise their experience and outcomes. One relative told us, “My [Person] is stone deaf, and I remember them (staff) telling me a while back staff used a board to write on to communicate with them.” There was a lack of communication tools in the service to evidence people were communicated with in a way that they could engage with. Leaders told us, picture cards, photos and show plates were used to help people choose their meals. During our visits to the service, we did not see any methods or tools being used to help people make an informed choice about what they wanted to eat. Using pictures and photos can help people to visually make choices if they have difficulty with processing words.

The provider did not promote people’s independence, so people did not know their rights and have choice and control over their own care, treatment and wellbeing.People were not supported to have control over day-to-day routines and were not provided with choices about activities they wanted to participate in. One relative said, ‘I’m not sure too many residents get a choice about what they do. There is a routine at Quenby, and they like them up, dressed and in the bottom lounge for breakfast. There are not enough staff for a variation of this really.” Another relative told us, “[Person] likes to sleep late, but they seem to get everyone up, washed and dressed and down in the lounge in the morning, I don’t think they have enough staff to look after residents in their rooms as well.’ On day 2 of our site visits at 6am in the morning, we observed 1 person was already up and dressed, and staff had begun to get other people up. Staff told us they only get those up who request to or if they are awake after receiving personal care.

Whilst we saw some positive interactions of staff supporting some people to eat and move independently, people told us they did not feel staff always effectively balanced providing support whilst empowering them to maintain their independence. One person had commented in a recent resident’s feedback survey, “I don’t mind being assisted with feeding, but I like to feed myself with assistance.”

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.The provider did not provide adequate resources to enable staff to understand and offer the right support to people to either prevent distress or when they were becoming distressed. Staff spoken with were not clear on how to support people demonstrating anxiety and, or distress. They did not really understand about diversion strategies, such as redirecting people’s attention away from the viewed negative behaviour towards a different, more positive activity or topic. The solution in all cases, was to ‘leave them to calm down’. Whilst this may be a solution in some instances, care plans and risk assessments failed to identify the triggers causing the person’s distress. Staff should be aware of how to actively support individuals through personalised strategies to anticipate and meet their needs quickly and in ways that reduced and mitigated people’s discomfort and distress.

Relatives told us, staff were alert to people’s healthcare needs and responded in a timely manner. One relative told us, “At the beginning of the year, it did get a bit manic when [Person] got a gastric infection. When the carers spotted it, they ended up in hospital overnight and on antibiotics afterwards.” However, relatives also told us, there was a lack of feedback after the initial contact regarding any changes in their relative’s health.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.Our previous assessment found, staff were not confident to raise concerns due to the fear that they would be blamed or treated negatively if they did so. At this assessment the manager told us they were working with staff to build trust through flash meetings, 1:1 supervision, and open-door leadership to change the culture in the service and ensure staff felt valued. The manager told us, when they started in April none of the staff had had a supervision. Their priority was to ensure residents were happy and safe by ensuring staff received supervision, appraisal and training. Whilst the manager told us, supervisions were carried out every 3 months, we requested to review supervision and competency assessments for staff. However, these were not provided to us to demonstrate staff were receiving one to one support in a protected environment, to discuss concerns in care delivery. A staff member commented in a survey that teamwork was a challenging part of their work, ‘Sometimes it’s very hard to tackle the situation and I am unable to deliver a good service.’ For suggestions for improving dementia care at the service they commented, ‘I need time for the residents to understand and tackle situations when sometimes I feel alone and left alone.’