Quinnell House

We found the following examples of good practice.

The home was very clean and well maintained. There was regular cleaning throughout the day and this included high-touch areas. The housekeeping staff were knowledgeable regarding current Covid-19 cleaning guidelines and robust cleaning schedules were in place.

The home was currently closed to all visitors apart from those who were on a palliative care pathway and end of life. Staff supported people to remain in contact with their families through phone and video calls at this time. There was a visiting policy to support visitors once the home re-opens to visitors. There was also a visiting room with an outside entrance where families will be able to meet their loved ones' safely.

There were systems in place to ensure that people who had tested positive for Covid-19 and were unwell and self-isolating were cared for in their bedrooms to minimise the risk of spreading the virus. The layout of the premises had allowed zoning to reduce risk of Covid-19 spreading. Zoning is a strategy to dedicate one specific area of the home to people who have tested positive to Covid-19. This also allowed for a separate staff team to work safely.

There was a ten bedded unit which had been used as the Covid-19 positive unit during an outbreak. Going forward this will be used as an admission unit for the 14-day isolation period before people are moved to a room of their choice.

Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. They were seen to be following correct infection prevention and control practices (IPC). Hand sanitiser was readily available throughout the home. Regular testing for people and staff was taking place. All staff have a weekly polymerase chain reaction (PCR) and daily lateral flow test (LFT). In addition, they have their temperatures taken daily. People have a monthly PCR test with twice daily temperatures and oxygen level checks.

At present the majority of people chose to spend time in their rooms. Staff were supported people to remain engaged with one to one activities. People who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people.

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 safe, effective, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met but improvements were needed in well-led to ensure that quality assurance systems were further improved and embedded in to every day practices.

Quinnell House 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. Quinnell House was registered to provide support to a maximum of 56 people who lived with dementia. The service does not provide nursing care on site and used district nurses to provide support when needed. 38 people were living at Quinnell House at the time of our inspection.

The service had a registered manager. 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their provider information return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Quinnell House has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been sustained.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, we found that audits were not consistently effective as they had not identified shortfalls in the management of diabetes and not all records to support the care delivered were consistently completed.

People told us they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of people with specific health disorders, such as diabetes. Formal personal development plans, including two monthly supervisions and annual appraisals were in place. Staff were supported to become ‘champions’ in areas of care delivery such as medicines and moving and handling. People were supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were encouraged and supported to eat and drink well. There was a varied daily choice of meals and people were able to give feedback and have choice in what they ate and drank. The dining experience was pleasant and inductive to encouraging people to eat. People chose where to sit and it was a pleasant and social experience. One person said "The food here is excellent as good as a restaurant, fresh fruit, cakes and we can have anything at any time if we are hungry." Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. The service worked well with allied health professionals

People felt well looked after and supported. We observed friendly and genuine relationships had developed between people and staff. People told us, “Staff are kind and lovely, nothing is too much trouble,” and “Very happy here, very caring.” Visitors told us, “Impressed with their kindness and knowledge,” and “I trust them and they have never let me down.” Care plans described people’s preferences and needs in relevant areas, including communication, and they were encouraged to be as independent as possible. People chose how to spend their day and staff were seen to support and guide people with kindness and empathy.

People were supported in a personalised way that reflected their individual needs. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff. Activities were provided throughout the day, seven days a week and were developed in line with people's preferences and interests. Further ideas for the prevention of social isolation for people who remained in their rooms were being discussed by the management team. Technology was used to keep families up to date if they lived away this was via protected internet access so they could discuss their loved ones’ care. There was a complaints policy and form available to people. Staff were open to any complaints and understood that responding to people’s concerns was a part of good care. People received a pain free and dignified death at the end of their lives. Staff supported people with compassion and worked with local hospice teams as required.

People and staff were positive about the culture of the service, staff and relatives felt the staff team were approachable and polite. The staff team worked in partnership with other organisations at a local and national level to make sure they were following current good practice. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service. Relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

Staff said the management team was fair and approachable, care meetings were held every morning to discuss people's changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available and they would be happy to talk to them if they had any concerns.

The provider had sent CQC notifications in a timely manner. Notifications are changes, events or incidents that the service must inform us about.

A manager was in post but they were not the 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 and associated Regulations about how the service is run. The manager had been in post nearly six months and was in the process of applying to become the registered manager.

At the last inspection undertaken on the 19 and 20 April 2016, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the principles of the Mental Capacity Act 2005 not being adhered to. People’s confidential information had not been maintained and the delivery of care was not consistently person-centred. Recommendations were also made in relation to the use of ‘as required medicines’ and maintaining accurate and complete records. The provider sent us an action plan stating they would have addressed all of these concerns by June 2016. At this inspection we found the provider had made improvements to the management of ‘as required’ medicines and people’s confidential information. However, improvements were not yet fully embedded and the provider continued to breach the regulations relating to the other areas.

The principles of the Mental Capacity Act (MCA) 2005 were still not consistently applied in practice. People’s capacity to consent to the use of bed rails and their bedroom door being locked had not been assessed. Where people were unable to use their call bell to summon assistance, risk assessments were not consistently in place. For people who required two hourly checks to maintain their safely, documentation failed to support that these checks took place.

The risk of social isolation had not consistently been mitigated. The registered provider had failed to maintain accurate, complete and contemporaneous records. People’s monitoring charts were incomplete and failed to evidence the level of care that people received. Documentation was in place for the recording of incident and accidents. However, subsequent follow up information was not recorded and incidents and accidents were not audited for any emerging trends, themes or patterns. We have made a recommendation for improvement.

People received their medicines on time and safely. Medicine profiles were in place alongside clear protocols for the use of ‘as required’ medicines. However, where people received covert medicines (medicines disguised in food), underpinning documentation was not available to confirm whether the person consented to this or whether it was done in their best interest. We have made a recommendation for improvement.

End of life care plans were not yet consistently in place. Weekly cleaning schedules for the kitchen had not been maintained and the extraction hood in the kitchen had a layer of dust and grease. We have made recommendations for improvement.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application to restrict people's freedom had been submitted.

The registered provider and manager were committed to the on-going improvement of Quinnell House. The manager told us, “We have a long way to go but we are getting there.” Best practice guidelines were followed in relation to dementia care and ensuring the environment was dementia friendly. A 16 week training programme on dementia care had been provided to care staff and staff spoke highly of the training provided.

People were protected, as far as possible, by a safe recruitment system. People and staff felt staffing levels were sufficient and risks associated with the environment were managed. Safeguarding adult's procedures were robust and staff understood how to safeguard the people they supported from abuse. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

Staff had a good understanding of people's needs and treated them with respect and protected their dignity when supporting them. We saw many positive interactions and people enjoyed talking to the staff. The importance of promoting independence was understood by staff and staff told us how they protected people's privacy and dignity.

A range of group activities took place which people spoke highly of. One person told us, “I love the quizzes.” People had access to a variety of food and drink and the manager was taking steps to improve people’s dining experience.

People, relatives and staff spoke highly of the new manager. One staff member told us, “They’ve made a lot of positive changes since coming into post and I feel much more supported now.” A visiting relative told us, “Quinnell House is the right place for our loved one.”

Fire evacuation procedures were in the process of being completed. People had individual maintaining safe and emergency evacuation care plans which considered the level of assistance required to aid a safe evacuation and what equipment would be needed.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.

There was a manager in post who was registered with the CQC. 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.

Staff were trained to protect people from abuse and harm. Staff could identify the signs of abuse and who to report to if they had any concerns. The provider had in place policies and procedures to record, investigate and track any safeguarding concerns. Staff were aware of these policies and procedures.

There were sufficient numbers of staff to keep people and safe and meet their needs. The provider had a system in place that allowed the register manager to recruit more staff when the numbers of people living at the home increased.

Medicines were stored and disposed of safely. Staff were trained in the safe administration of medicines. However, there were gaps in the application of creams. This could put people at risk, as there could have been applications that were missed. We have made a recommendation about this in our report.

The principles of the Mental Capacity Act (MCA) were not consistently applied in practice. Where people were unable to give consent to aspects of their care an assessment of their capacity had not always been completed. This put people at risk as staff could make assumptions about their ability to make their own decisions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People were supported to maintain a balanced diet. People were provided meals that met their nutritional needs and choice preferences. The provider had carried out assessments of people to identify those at risk with their eating and drinking.

People were supported to maintain good health. People were being referred to appropriate health professionals when needed. This included referrals to GPs, district nurses and dieticians.

The provider had not ensured that all information was provided in format to meet people’s varied communicational needs. We have made a recommendation about this in our report.

People told us they were happy with the staff and felt supported with their care. Staff were seen to be communicating with people in a kind and caring way.

People and their relatives were not always involved with the reviews of care plans. Staff would carry out regular reviews of care plans and the registered manager sent out letters to relatives to inform them of reviews, however, some people told us they had not seen a care plan. People had pre-admission assessments that gave staff basic information. However, detailed care plans were not developed in time to give people full support during their first days at the service.

People’s private information and personal documentation was not always respected and stored securely. Handover took place in a communal area with people living at the service in the same room. People’s care plans were kept in a room that was, on occasions, left unlocked and unattended.

People and those important to them were encouraged to give feedback on their experiences of the service they received through meetings, surveys, suggestions and complaints. The provider had a system in place to ensure that all complaints received were fully investigated by the registered manager. All outcomes were effectively communicated to all interested parties.

People were supported to make their own choices at the service. People could choose what they would like eat and were encourage to decorate their rooms to their own tastes.

Staff are encouraged to contribute to the improvements of the service. Staff attended meetings where they could express their views and the provider carried out a staff survey. Staff told us they were happy that they could also express their views directly to the registered manager.

The registered manager had not ensured that all records were up to date. There were gaps in people’s records when staff had to fill out paper records instead of putting them straight on the computer system. The registered manager had not ensured that audits had identified all shortfalls within the service.

People living at the service, staff and relatives spoke positively about the registered manager. The registered manager had an open door policy that was used by people, relatives and staff.

On inspection we found breaches in Regulations. You can see what action we told the provider to take at the back of the full version of the report.