Background to this inspection
Updated
28 March 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
We checked whether the provider had met the requirements of the Warning Notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
This inspection was carried out by three inspectors on the first day, two inspectors on the second day and one inspector on the third day. An Expert by Experience supported the inspection by making phone calls to people’s relatives. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Living Plus Healthcare trading as Queen Anne Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Queen Anne Lodge is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post. There was also a consultant manager, who the provider had employed prior to our last inspection in May 2022. The consultant manager became the provider’s nominated individual on the first day of this inspection. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, including the statutory notifications we had received from the provider. Statutory notifications are reports about changes, events or incidents the provider is legally obliged to send to us. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with five people who used the service and nine relatives about their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with thirteen members of staff including the registered manager, the nominated individual, the deputy manager, nurses, care workers, an activities staff member and kitchen staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received feedback from three external professionals.
Updated
28 March 2023
About the service
Living Plus Healthcare trading as Queen Anne Lodge is a residential care home providing personal and nursing care to up to 40 people. The service provides support to people aged 65 and over including people living with dementia. At the time of our inspection there were 19 people using the service.
People’s experience of using this service and what we found
At this inspection we found the provider had failed to address the continued breaches of regulation identified at our previous two inspections in May 2019 and May 2022. The provider had submitted an action plan following the last inspection, but had failed to make or sustain improvements in these areas.
Whilst people and their relatives told us they felt the service provided a good standard of care, we continued to find systems in place to reduce risks to people, were not safely managed. Risks to people had not always been assessed or monitored and staff did not have guidance to effectively reduce those risks. Care plans and risk assessments did not identify essential information to ensure people were supported in a safe way.
Risks to people from the premises and equipment were not always safely managed. Although improvements were being made to fire safety, people did not have detailed emergency evacuation plans, risks from equipment were not always assessed and the cleaning and storage of emergency equipment to ensure it was available and safe to use, was not robust.
Safe and effective infection control procedures were not fully embedded to ensure people were protected from the risk of infection
Medicines had not been safely managed as stock levels were not monitored effectively, expired medicines had not been disposed of appropriately and medicines administration records did not all contain essential information. This placed people at increased risk of harm.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
People told us they were supported to access healthcare services when required. However, information relating to people's health needs was not always clearly documented within people's care plans.
People received enough to eat and drink and told us they enjoyed the food. However, where people had specific dietary requirements, information about risks was not always recorded.
Quality and safety monitoring systems were not robust. Governance processes and systems in place to help ensure the safe running of the service had not identified all the concerns we found. This meant the provider and registered manager could not be proactive in identifying issues and concerns in a timely way and acting on these.
There were enough staff available to support people. Recruitment processes were safe to ensure only suitable people were employed. The provider had a policy and procedure for safeguarding adults and the manager and staff understood the signs to look for.
Staff had received appropriate training and support to enable them to meet people’s needs. They received supervision to help develop their skills and support them in their role.
There were processes in place to monitor incidents, accidents and near misses so action could be taken to address issues when needed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 6 August 2022) and there were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations. This service has been rated requires improvement or inadequate for the last three consecutive inspections.
At our last inspection we recommended the provider considers current guidance on the prevention and control of the spread of infections and updates their practice accordingly and seek advice and guidance from a reputable source on the management of people’s nutrition and hydration needs. At this inspection we found the provider had not fully acted to reduce risks to people from infection control or their nutrition and hydration needs.
Why we inspected
We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 17 (Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met and to confirm if they now met legal requirements.
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 see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Living plus healthcare t/a Queen Anne Lodge on our website at www.cqc.org.uk.
Enforcement
We have identified the provider failed to fully address the action we told them to following our last inspection. There were continued breaches in relation to safe care and treatment, person centred care, the need for consent and governance at this inspection.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.