Queens Meadow Care Home

Queens Meadow Care Home provides personal care for up to 59 people, some of whom are living with dementia. At the time of the inspection there were 54 people living in the home.

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

People felt safe living in the home. People spoke fondly of the staff. Comments included, “I absolutely love [care staff], they always look after me and know what I need" and, “They do try to look after me. They kid on with me and I like that.” Staff did not always manage people’s medicines effectively. The provider had made some improvements to medicines management. However, further developments were needed to ensure the safe management of medicines. We have made a recommendation about this.

People were safeguarded from abuse. Risks to individuals and the environment were managed. There were generally enough staff to meet people’s needs. The provider learned from accidents and incidents to mitigate future risks. Infection control processes were embedded into the service and staff followed government guidance in relation to infection control and prevention practices, in particular, relating to COVID-19.

People’s needs were assessed before they moved into the home and on an ongoing basis. Staff were suitably trained and received regular supervisions. People were supported with their nutritional needs and to access a range of health care professionals. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

A new manager had been recruited and was working their notice in another role at the time of the inspection. There was an interim manager in post who had worked in the home for over 15 years as the deputy manager. They were being supported by the regional manager and interim deputy manager. The atmosphere in the home was calm and relaxed. The provider had quality assurance processes in place which included regular audits by management in the home as well as the regional manager. People and relatives were regularly consulted about the quality of the service through surveys, meetings and reviews.

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 good (published 21 November 2018).

Why we inspected

We received concerns in relation to medicines management, governance and the overall management of the home. As a result, we decided to undertake a focused inspection to review the key questions of safe and well-led only.

During the inspection we found areas of potential concern relating to nutrition and hydration and staff training. We therefore decided to also inspect the key question effective.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

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.

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

Follow up

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

We found the following examples of good practice:

¿ There were appropriate measures in place to prevent visitors catching and spreading infection. Visitors were asked to complete a brief questionnaire about their current health status. Visitors were supported to wear appropriate personal protective equipment (PPE) and there was plenty of PPE available.

¿ Systems were in place to support people to maintain contact with their family. This included the use of electronic tablets and telephones. The service had also created a safe area where relatives could visit, whilst adhering to government guidelines.

¿ Staff had completed specific COVID-19 training, including the correct use of PPE.

¿ The registered manager told us both people and staff underwent regular COVID-19 testing in line with government guidelines. The frequency of tests was in line with current guidance.

¿ The home was clean and hygienic. Daily cleaning schedules were in place to ensure more frequent cleaning was completed including frequently touched surfaces. Appropriate cleaning products were used to reduce the risk of infection spreading.

Queens Meadow Care Home is a detached building set out over two floors. Each floor has their own adapted facilities. There is also a large, secure outdoor area.

We found the following examples of good practice.

• Systems were in place to prevent people, staff and visitors from spreading infections. The home proudly spoke of how there had been no known cases of Covid-19. The home had made adaptions to support social distancing. Increased cleaning was being carried out.

• Staff had undertaken training in putting on and taking off PPE, hand hygiene and other Covid-19 related training. Infection control lead staff were in place who monitored staff practices and provided training to ensure the national guidance was being followed. The provider continuously shared important information about Covid-19 to staff.

• Staff supported people’s emotional and social wellbeing. People were supported to keep in contact with friends and relatives through telephone calls, social media and outdoor visits by an appointment system. National guidance was being followed to ensure visits took place at a safe social distance.

• The home was following national guidance for people moving into the home. Staff worked with people and their relatives to ensure they were aware of isolation procedures. People were supported by a dedicated staff team who ensured any feelings of isolation and loneliness was reduced. A range of individual social activities, reminiscence sessions, pamper sessions and contact with friends and family were provided.

• The home undertook a range of infection control audits and checks. The registered manager spoke positively about the hard work and dedication which staff had shown, which had helped to minimise the impact of the pandemic on people’s health and wellbeing.

Queens Meadow is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Queens Meadow provides personal care for up to 59 people. At the time of our inspection there were 58 people living at the home who received personal care, some of whom were living with a dementia.

We last inspected Queens Meadow in August 2017 and rated the service requires improvement. We found an ongoing breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 which relates to good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions relating to safe, responsive and well-led to at least good. At this inspection we found that significant improvements had been made in the key questions responsive and well-led. Although a number of improvements had been made relating to the key question safe, further improvement was still needed in this area. This was because people’s personal emergency evacuation plans were not always up to date and detailed enough, guidance on ‘when required’ medicines was not detailed enough, and the temperature records of areas where medicines were stored were incomplete. The registered manager and provider took immediate action to address these areas during our visit. Due to the significant improvements made the rating for this service has now improved to good.

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

During this inspection we found there was a welcoming and homely atmosphere at the service. People were at ease with staff and relatives said staff were kind and caring. Staff respected people's privacy and dignity. There were positive relationships between people, relatives and staff.

People and relatives spoke positively about the care provided. People told us they felt safe.

Staff had received training in safeguarding and knew how to respond to any concerns. Safeguarding referrals had been made to the local authority appropriately, in line with set protocols.

A thorough recruitment and selection process was in place which ensured staff had the right skills and experience to support people who used the service.

Staff training in key areas was up to date. Staff received regular supervisions and appraisals and told us they felt supported.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to have enough to eat and drink and attend appointments with healthcare professionals.

Care plans were detailed and person-centred and contained important information about people’s life stories so staff could get to know people well.

People and relatives knew how to make a complaint and were happy approaching staff or the registered manager if they had any concerns.

People were supported to engage in meaningful activities and access the local community.

People, relatives and staff spoke positively about the registered manager being approachable.

Staff said they felt supported and able to raise issues at any time.

The home had good links with the local community and people told us how much they enjoyed this.

In July 2016 we carried out an inspection of this home and found three breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. We issued requirement notices to the provider in respect of these breaches. They related to people not being protected from the risk of inconsistent care because care records were not sufficiently detailed to provide clear guidance for staff, and people not being protected against risks associated with unsafe infection control and prevention practices. In addition, daily health and safety checks had not always been carried out and the provider’s quality assurance system was not effective in addressing the shortfalls we found at that inspection.

We asked the provider to submit an action plan in response to our findings, setting out how the matters would be addressed. At this inspection we found that overall, improvements had been made. However, we found that not all of the actions set out in the provider’s action plan had been completed and shortfalls continued in respect of the requirements of one regulation.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

We found some people now had personalised care plans in place which contained their preferences and likes and dislike, but some people’s files still required updating to include more personalised detail. The provider had an improvement plan in place to ensure all people’s care plans were personalised. Staff had received training in care planning to support this work.

We found some actions regarding infection control had been completed. However, further improvements were required to ensure the environment could be cleaned to an acceptable level. The provider had included this work in their action plan. After our visit to the home as part of this inspection, we have written to the provider and gained assurances that environmental work will be completed in planned stages over a three month period.

We have made a recommendation about the management of infection control.

We found remedial work identified at a previous fire risk assessment had not been fully completed. At the time of writing this report we have gained assurances from the Fire Service that they deem the service to be safe, as they have inspected the service in January 2017 and do not plan to revisit ahead of their usual programme of inspection. We have addressed the lack of progress in respect of this remedial work with the provider and obtained assurances from them that this work will be completed by the end of October 2017.

We found some care records pertaining to food and fluid intake were not completed correctly.

We found cleaning records were not always completed consistently. Cleaning schedules did not set out timescales for specific deep cleaning tasks.

The provider had a quality assurance audit planner in place to ensure the quality of the care provided was monitored on a regular basis. During the inspection improvements were noted but not to a level to demonstrate the improvements in the service were sustainable. The quality assurance audits at this inspection had not identified the concerns we found in relation to record keeping. We found audits and action plans associated with the quality assurance process did not always record managerial review.

People said they were comfortable and felt safe living at the home. Staff had been recruited in a safe way to make sure they were suitable for their role. People, relatives and staff felt staffing levels were appropriate to meet the needs of the service. The manager used a dependency tool to determine staffing levels.

The provider had policies and procedures in place for safeguarding and whistleblowing. Staff understood how to report any concerns and were confident these would be dealt with by the manager.

Accidents, incidents and safeguarding concerns were recorded and analysed by the manager to look for themes or patterns.

Staff felt supported by the management team. They received individual supervision sessions and appraisals to assist them with their professional development. The manager used an electronic training matrix to manage staff compliance with essential training.

People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments. Staff understood the importance of identifying changes in people’s health and well-being to ensure prompt referrals to the appropriate professional when needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

People and relatives told us staff were kind and caring and we observed that staff were respectful and helpful when supporting people. Staff promoted people's independence through encouragement and offering choice. There were friendly, good relationships between staff and the people who lived at the home. People enjoyed a varied diet and chose from a menu which was nutritionally balanced.

People had access to a range of recreational activities both inside the home setting and within the local community. People told us they enjoyed the activities provided and felt included in planning.

The provider had a complaints procedure in place. People and relatives felt the manager would act on any concerns or complaints they made, should this be necessary.

People and relatives felt the manager was open and approachable. The regional manager supported the manager with regular visits to monitor quality and compliance. We found quality audits had been completed, however not all actions from the audit process had been addressed. The quality assurance system had not identified the issues found at this inspection.

Relatives and people had opportunities to give their views and opinions. Meetings were held on regular basis for people, relatives and staff.

The manager developed and maintained links with outside agencies to improve the quality of support provided by acknowledging best practice. Staff were part of a pilot to prevent or reduce admissions and attendances to hospital.

We identified one breach of the Health and Social Care Act (Regulated Activities) Regulations 2014, namely Good governance. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place over two days. The first visit on 7 July 2016 was unannounced which meant the provider and staff did not know we were coming. Another visit was made on 8 July 2016 which was announced.

Queens Meadow is a purpose-built care home which provides personal care for older people, some of whom are living with dementia. It is registered for 59 places. At the time of this visit there were 54 people living at the home, including two people on short breaks.

The home had a registered manager who had been in this role for several years. 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.

During this inspection we found the service did not always make sure that risks were managed. For example, safety checks had not always been carried out and some areas of bathrooms could not be kept fully clean because they had surfaces that were not sealed.

Care records were not always sufficiently detailed to make sure people received personalised and consistent care.

The provider’s quality monitoring processes were not fully effective in making sure people received a safe or quality service. This was because shortfalls had been identified but action had not always been taken to address them.

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

The people and relatives we spoke with felt the home provided a safe and comfortable place for people to live. One person commented, “I’d rather be in my own home, but I know I’m safer here.” A relative commented, “I can leave without worrying about her because I know they look after her.”

Staff were clear about how to recognise and report any suspicions of abuse. Staff told us they were confident that any concerns would be listened to and investigated to make sure people were protected. The provider made sure only suitable staff were employed, although there were no regular renewals of checks for long-term staff.

There were enough staff to support people with their needs. One relative said, “There always seems to be enough staff.” Another visitor commented, “There are always staff around when we visit.” People were assisted with their medicines in the right way.

People and relatives felt staff were well trained and experienced. Staff understood the Mental Capacity Act 2005 for people who lacked capacity to make a decision.

Health and social care professionals said the staff cared for people in a competent, effective way and responded appropriately to any changes in people’s well-being. People were supported to eat and drink enough and they had choices about their meals.

People felt the staff were “caring” and “friendly”. For example one person said, “The lasses are lovely.” Another person told us, “It’s a nice home and the girls are smashing.”

Relatives said the home was “caring” and “supportive”. One relative commented, “My [family member] says she’s well looked after and they are lovely to her. They need medals for the job they do.” Another relative told us, “We really like it and my [family member] is happy here. They’ve been settled since the day they moved in and staff are really good with my [family member]. They are as happy here as they have ever been.”

Staff were knowledgeable about people’s history as well as their likes and dislikes. A relative told us, “It’s a very stable staff team so they know people’s needs, and people are familiar with staffs’ faces and voices which is really important for people with dementia.” A care professional said, “The staff in the home tend to know the residents very well.”

It was good practice that the home had links with the North Tees Dementia Collaborative to make sure its service was informed, involved and up to date with best practices in relation to the care of people living with dementia. In discussions all the staff we spoke with were enthusiastic about finding fresh ways of supporting people living with dementia. For example, for the past nine months the home had kept hens in one of the gardens so that people could be involved in looking after them. Hen therapy can successfully help people with depression and loneliness.

People had opportunities to join in activities or go out with staff from time to time. The activities co-ordinator planned activities on each floor each day. There was a diary of events displayed in communal areas for people.

People had information about how to make a complaint and they were confident these would be acted upon. People, relatives and staff felt the registered manager was approachable.

People and relatives felt the home was well-run. One relative said, “It’s well-managed. I would recommend it.” Health and social care professionals told us they thought the home seemed “well run” and that the registered manager was “very competent”.

We used a number of different methods to help us understand the experiences of people who used the service, because some people had complex needs which meant they were not able to tell us their experiences.

We found that people had their needs assessed and that care plans were in place. People we spoke with told us they liked living at the home. The people we spoke with were satisfied with the service they received.

People who used the service were protected from the risk of abuse and told us they felt comfortable and safe with staff.

We found that systems were in place to ensure medicines were administered safely.

The quality of the service was monitored and reviewed on a regular basis.

We found that records within the service were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.

We spent time observing how staff supported people who lived at the home. People we spoke with said they were happy with the staff. They told us 'I couldn't do without them', 'Staff are alright', and 'Everyone's pleasant.'

People were generally very happy with the care provided. Comments included 'The staff are lovely, they know people really well", 'I enjoy it here' and 'The girls are very caring.'

We also saw evidence that staff employed had been through recruitment checks prior to commencing employment. This demonstrated people's health and welfare needs were being met by staff who were fit to do their job.

People said that they knew they could speak to a member of staff if they had a complaint. One person said "I would say straight away if I wasn't happy about something", another said 'If we have any problems we can tell them.'

We saw some care plans and daily notes did not contain up to date information. This meant people were not being protected against the risks of inappropriate care as records were not always accurate and fit for purpose.