Archived: Queensway House

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection we found that there were not always sufficient numbers of suitable staff available to meet people’s needs consistently across all areas of the home. At this inspection we found that staff were not effectively deployed across the home to meet people`s needs effectively and people`s dependencies were not correctly calculated to ensure these were reflected in staffing numbers. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.

Staff were knowledgeable about the risks of potential abuse and knew how to report any concerns they had internally and externally to local safeguarding authorities. Risk assessments were in place to give staff guidance in how to mitigate risks to people`s well-being, however these were not always followed by staff in relation to pressure management and choking risk.

People who lived at the home and their relatives were positive about the skills and abilities of permanent care staff. However they were not as confident in the abilities and skills of the agency staff working at the home. Staff were trained and they felt supported by the management team at the home.

At the last inspection we found that food and fluid records were completed retrospectively, and where people needed their intake monitored, food records did not document the amount people had eaten. We found that this practice had not improved and staff who completed these records were not always the staff who supported people to eat and drink.

Queensway House has had a consistent registered manager, deputy manager and team leaders in post for a long period of time. In this inspection we found that the management team were not effective in Queensway House to implement and monitor the requirements from the inspection we carried out on 14 September 2016.

The standard of cleanliness in the home had improved. Some areas of the home were freshly decorated and there were no unpleasant odours around the home. However we found that the equipment used by staff to assist people with their mobility like hoist and rota stand was not as clean as it should have been.

Most relatives and care staff told us they had been involved, to varying degrees, in the planning of the care and support their family members received when they moved in the home. However, some people could not recall having been involved and their consent was not always accurately reflected in their individual plans of care.

People were cared for in a kind and compassionate way by permanent staff who knew them well and were familiar with their individual needs, preferences and personal circumstances. We saw that most permanent staff members had developed positive and caring relationships with people who lived at the home. They provided care and support in a respectful way, however in many cases people`s dignity was not upheld, their clothes were stained, they had no socks on and their footwear had dried food stains. Staff were not always attentive to clean people`s face and mouth after they assisted them to eat.

People were able to decide how they wanted to spend their days. We saw people on the ground floor engaged in activities around the home, reading newspapers, listening to music and chatting with each other. However people living on the first floor whose dementia was more advanced had little access to other parts of the home.

The system of meetings was not effectively led by the registered manager who was not able to maintain an oversight of the issues within their own home

The registered manager was supported by the provider, the regional manager, the hospitality manager and a dementia manager to implement and sustain improvements to the quality of the care people received in Queensway House. In addition there was support from the local authority, home improvement nurse and the district nurse team to ensure the care and support people received met their health and social needs. However the registered manager failed to ensure that the improvements needed were successfully implemented and sustained.

People’s medicines were not always managed safely. Medicine records were not completed accurately and not always signed by staff when they administered people`s medicines. When we reconciled medicines for people we found that the amount of tablets had not always corresponded with the amount on the medicine administration record (MAR).

At this inspection we found the service to be in breach of Regulations 8, 12, 10, 11, 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were not always sufficient numbers of suitable staff available to meet people’s needs consistently across all areas of the home. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.

Staff were knowledgeable about the risks of potential abuse and knew how to report any concerns they had internally and externally to local safeguarding authorities. However not all reportable incidents had been reported to the local safeguarding authorities or CQC. Steps were not always taken to mitigate and reduce identified risks relating to behaviour that challenged and to protect people from the risk of harm.

People who lived at the home and their relatives were positive about the skills and abilities of permanent care staff. However a significant number of staff were not up to date with refresher training in key areas such as safeguarding, infection control, dementia, skin integrity, care planning and first aid. There was a high percent of agency staff working at the home of whom more than half had not received basic dementia awareness training although the majority of the people living in Queensway House lived with dementia.

People’s records were not always stored securely. Food and fluid records were completed retrospectively, and where people needed their intake monitored, food records did not document the amount people had eaten. People`s care plans were not always reflective of their current needs.

Daily health and safety walk arounds were not regularly completed. We found that a fire escape was blocked by a wheelchair and two mattresses and the general condition of the building was not well maintained. Throughout the home we saw liquid and splashes on the walls, and toilets when used were not flushed. The home had not been decorated to provide a dementia friendly environment, walls were bare, dining rooms had not been given a purpose so people could be prompted to sit and enjoy their meals.

The standard of cleanliness in the home was poor and cleaning schedules in bathrooms and toilets were not completed daily. There were malodours around the home which had not cleared after cleaning. The flooring around toilets was discoloured and stained and bare wooden boards covering the pipe work under sinks presented infection control risks.

Staff told us they had regular supervisions and felt supported by the home management team; however they were disappointed by the provider’s lack of response when staff requested meetings with them to discuss on-going issues in the home which were outside the registered manager’s remit to address. There was no evidence of regular staff meetings and staff were not able to tell us when the last meeting was for them to share their worries and discuss how the home operated.

Most relatives and carers told us they had been involved, to varying degrees, in the planning and reviews of the care and support their family members received. However, some people could not recall having been involved and their consent was not always accurately reflected in their individual plans of care.

People were cared for in a kind and compassionate way by permanent staff who knew them well and were familiar with their individual needs, preferences and personal circumstances. However, some agency staff members did not know the service well and were unfamiliar with people’s needs and preferences.

We saw that most permanent staff members had developed positive and caring relationships with people who lived at the home. They provided care and support in a respectful way, however in many cases people`s dignity was not upheld, their personal hygiene needs were not always met, people had malodours around them and their clothes were not changed after meals if there was a need for it.

People were able to decide how they wanted to spend their days. We saw people on the ground floor engaged in activities around the home, sitting outside and having a tea morning, reading newspapers. People on the first floor whose dementia was more advanced and people who could not leave their bedrooms had little to do to occupy their times.

Weekly audits were submitted by the registered manager to report to the provider key areas of concern and improvement in the home. We found that these had addressed some of the concerns we identified though the inspection, however failed to identify many others and the actions in place had not been carried out effectively to improve the service provided. The provider failed to ensure that the monthly audits required to be carried out by the regional manager were regularly done and effective in identifying all the areas in need of improvement.

People who were nearing the end of their life received kind and compassionate care from staff. There were strong links developed by the management team with local hospices which helped staff get specialist advice when people`s condition declined.

At the time of the inspection the registered manager was supported by the provider`s quality team who begun to review the care in Queensway House and had already undertaken steps to identify areas requiring improvement.

People’s medicines were managed safely and given to people as intended by the prescriber. Medicine records were completed accurately and signed by staff when they administered people`s medicines. For those people who required their medicine to be given at a certain time and on a certain day we saw this had been given.

At this inspection we found the service to be in breach of Regulations 12, 11, 15, 10, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we asked the provider to take at the back of the full version of the report.

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm. We found that the staff were kind and caring and were aware of their duty of care to the people using the service. Discussions with the staff and a review of records showed that they had training in how to recognise signs of abuse. All the staff we spoke with told us that they would report any incidents and would ensure they were dealt with.

People who used the service told us that the staff were easy to talk to and therefore they could tell them anything. All of the people we spoke with told us that they felt safe.

However, we noted that mental capacity assessments had not been carried out on all those people who had memory loss and Deprivation of Liberty Safeguards authorisation had not been sought for all the people who had their freedom of movement curtailed. We were told that this was underway but had not yet been completed.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes and promoted a good quality of life which was evidence-based where possible.

We reviewed the care and support plans for ten people and we looked in depth at the care planning of eight people who lived at the home. We found that the care plans had been reviewed and now contained appropriate and personalised details to inform care staff how to support people in a way that met their individual needs.

All of the care plans we looked at had 'This is me', a form provided by the Alzheimer's Society to ensure more understanding of the person's needs and preferences. However, none of the staff we spoke with had time to read the care plans. People told us that while their physical needs were met, they were very bored. One of the people told us that they felt like a prisoner, as they were not able to go out when they wanted to as they needed to be accompanied by a staff member and that there was not enough staff to facilitate this.

Is the service caring?

By caring, we mean that staff involved the person in how they wanted their care delivered and that they treated people with compassion and kindness.

We observed the staff on duty to be caring and compassionate throughout the inspection. However, the staff appeared busy and they did not have time to spend talking with the people. We also saw that people were frequently left unattended. We noted that on two separate occasions, two people who used the service had been left unattended in a sitting room for over 10 minutes. During this time, one person was very distressed. We saw that they had no means of calling for assistance. We were told that the room was checked every 10 minutes.

We noted that some staff knew people they supported very well, including having good knowledge of their identified needs. However, not all staff were aware of the personal needs of the people. Some staff told us that they were not sure who they were caring for, as they had been a change since they last worked in that part of the home.

Is the service responsive?

By responsive, we mean that services were organised so that they recognised and met people's needs in a timely manner. We noted that many people fell asleep in their chairs in the afternoon and that none of them were offered the opportunity to return to their bedroom for a nap.

When we spoke to people, some of their comments were: 'I feel a lack of control of what I can do'. 'You lose your independence'. 'You have a choice when you get up, but sometimes you have to fit in with the staff.' When asked if they were ever asked for their opinion about how the home is run, people told us that they were not asked for their opinions and some of their comments included: 'No we are not asked what we think.' 'No I'm not asked and I'd like to be, that would be really helpful.' 'I feel I am under control of their time'. Another person said, 'We get browned off as there is nothing to do.' Other people said that they would like to pursue their hobbies, but are not given the opportunity or assistance. Other people said it would be nice to go out more.

We found that few people who stayed in their bedrooms had no access to call bells as they were unable to use them. We were told that those people who stayed in their rooms were checked on a regular basis.

The manager was unable to provide us with evidence on how the people were included in the running of the home. For example, they were not involved in menu planning or in the planning of activities. Activities were planned on a daily basis and people told us that there was no variety of activities provided. They told us that they were bored with taking part in same activities all the time. We noted that very few people stayed in their bedrooms. Staff told us that this was people's choice, but the people we spoke with did not agree with this view.

Lunch was served in a large dining room. This may not have suited some people who needed assistance with eating, as there was no privacy and it was difficult to assist people to eat in a manner that promoted their dignity and independence.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation assured the delivery of high-quality, person-centred care. We found that the home was not managed in a way that ensured safe and appropriate care for people who used the service. There was no evidence of involvement of the people in the planning of the running of the home. Audits were not carried out in enough detail to ensure that the service was safe and effective.

The home did not have sufficient staff on duty to meet people's needs. The staffing levels were reduced in the main home from 10 in the morning to seven in the afternoon. The staffing levels on the Sunflower unit was reduced from four in the morning to three in the afternoon. However, a review of staffing rotas showed that the staffing levels frequently went below this amount. We saw evidence that on one occasion, two staff members were supporting up to 20 people with varying and complex care needs. The manager was unable to tell us how they determined how many staff were required to support people living in the home. The people we spoke with told us that they wanted the home to improve, but they were not supported to discuss this with the manager.

We received mixed responses from the people who used the service and from their relatives about the care and support they received. Some people were happy with the service and others told us that they were bored and had nothing to do. One person we spoke to said "It is chaos. I would not have signed up for this." Another said "Everything here is okay". One person asked us why they were in prison.

A visiting relative told us " I am happy with the care. The staff are fine and keep me informed but there could be more activities for people". Another relative was happy with the care of their relative and said that they had become more social since coming to live at Queensway House. Other people said that they had very little choice about how they spent their time or what time they got up and went to bed.

Staff told us and we saw that they did not have time to spend with people. We found that the care was based on the tasks that needed to be done rather than on caring for the person. We found that the home was not hygienically clean and there were not sufficient procedures to prevent the spread of infection.

A visiting professional told us "the staff are very good and the level of care is very good."

A relative told us 'I am perfectly happy. If I was asked to recommend this home I would. The manager is very open and helpful. She keeps me informed and asks what I think about things. They look after (my relative) well and (they) always seem happy'.

We spoke with a professional who told us 'Staff manage people's support needs well. This is a good home.'

People were provided with a choice of suitable and nutritious food and drink. We saw that the food on offer at lunchtime was served hot and looked fresh and appealing on the plate.

We looked at medication policies which covered the supply, storage, administration and disposal of medication. There was clear guidance to staff in relation to covert administration of medication, the use of homely remedies and how the home should support people who wish to take their medication independently. We noted that the medication systems were audited on annually by a local pharmacist.

Staff received appropriate professional development. We saw that regular supervision was held with a senior level staff member. A staff member said 'I have regular supervision and it is useful. I can raise issues in between supervisions if I need to. The manager is very approachable.'

We saw the complaints policy was on display and included in the service users guide.

We saw that sufficient staff were always on shift to meet the needs of the people who used the service. The people who lived in the home commented on how happy they were. Other people stated that there is always something to do or something going on. We saw that the provider listened to people's views and requests and always took these into account when planning care.