Queens Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People told us they were happy living at the home and felt safe and well cared for.

Incidents and accidents, safeguarding concerns and complaints were recorded on the provider’s system. These were reviewed, discussed and analysed to determine any underlying causes or trends and to identify any actions required to improve the service. We saw evidence of learning recorded in an incident bulletin. A healthcare professional told us, “There is a no blame culture whereby staff are actively encouraged to raise issues/concerns about resident care. This has resulted in staff feeling more comfortable and able to report any incidents. Learning outcomes are shared, improving resident care and safety.”

The registered manager understood their responsibilities under the Duty of Candour. They told us, “At Queens Court, we are committed to maintaining transparency and honesty in all aspects of care, in line with the Duty of Candour.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

People told us they felt safe at the service. Their comments included, “Oh yes, I always feel safe here, there is always someone around if I need them” and “I have only been here two months but I am in better physical shape than when I arrived here.” Relatives confirmed they were informed when their family members required support or treatment from healthcare professionals.

The staff team and managers told us they worked well with other professionals to provide continuity of care, including when people moved between different services. Healthcare professionals told us they had a good working relationship with the service and communication was good.

Staff told us they were happy working at the home and felt supported and listened to.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People said they felt safe from harm and abuse and relatives agreed. One person told us, “I do feel safe, but it is difficult to explain exactly why. I have a call bell and someone usually comes pretty rapidly when I press it.”

Staff received training in safeguarding and were aware of their responsibility to safeguard people and knew who to contact in the event of any safeguarding concerns. One staff member told us, “If I had a safeguarding concern, firstly I’d make sure residents are safe, then I’d report it to the nurse and management team, document it, and contact the local authority, or call 999 if it is needed.”

The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred.

The provider understood their responsibilities under the Mental Capacity Act 2005 in ensuring Deprivation of Liberty safeguards (DoLS) applications were submitted as required.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People said staff knew their needs and met these safely. There were effective processes in place to ensure risks to people were assessed and mitigated. Risk assessments were clear, comprehensive and regularly reviewed. A member of staff told us, “Our risk assessments are always person centred, they are reviewed monthly on ‘Resident of the day’ or sooner if residents’ health conditions change.”

Hazards associated with using a wheelchair were recorded, such as risk of physical injury, risk of falls from poor positioning or poor moving and handling procedures. Measures in place to reduce risk included, ‘Colleagues to ensure foot plates of wheelchair are in position, regular checks and maintenance of the wheelchair and moving and handling training for staff’. On the day of our visit, we observed a visitor who came to take out a person, had briefly left the person in their wheelchair to get something. A staff member passing by saw that the wheelchair brake was not engaged and promptly secured it. This showed that staff were attentive to risks in the environment.

A person’s care plan indicated they were at ‘very high risk’ of skin deterioration and stated the person had refused the use of an air mattress recommended to prevent the development of pressure ulcers. As a result, the person was repositioned every 4 hours and had a foam cushion on their armchair to reduce this risk. We checked the charts and saw the checks were undertaken regularly.

Two people who were friends chose to walk together sharing a zimmer frame. We saw there were full and appropriate risk assessments for this which gave both people the freedom to continue in the way that made them happy. The home showed a strong acceptance of how people wanted to live, even if this sometimes seemed unwise.

Personal emergency evacuation plans were in place. These contained detailed information about each person and the support they required to safely evacuate the building in the event of a fire or other emergency.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People were supported in a safe and well-maintained environment that met their needs. People and relatives told us they liked the environment they lived in. The home had been developed to meet the needs of people living with dementia. This included clear colour distinction between wall and floor and wall and handrails. There was signage with words and pictures to indicate bathrooms and toilets. A digital clock for people in the dining rooms showed the date, time and weather. There were a couple of twiddle mats in the lounge and some people had soft toys in their rooms. Twiddle mats are sensory objects that help relieve anxiety in people living with dementia.

There were effective systems in place to monitor and regularly check the safety and upkeep of the premises. The management team and staff worked together to help ensure any potential risks were identified and addressed promptly such as faulty equipment or trip hazards. Safety checks were completed daily and weekly in all areas of the home to ensure safe systems were in place. These included water temperatures, fire safety checks and kitchen equipment. They also responded promptly to any reports from the staff where repairs were required.

Equipment used to support people was suitable, well maintained and stored securely. The provider had an up-to-date plan in place to help ensure people were supported in the event of an emergency.

The building was spacious and modern. There were many comfortable areas for sitting and chatting. The lounges were well set out and comfortable. There were doors leading out into a well-designed garden and upper floors benefited from large balconies. People could personalise their bedrooms as they wished.

On the day of our inspection, we found some areas of the building were hot, and some people who were staying in their rooms did not always have fans to keep themselves cool. We discussed this with the registered manager. They told us they would arrange a meeting to discuss this with people. They provided evidence of consultation with people after the inspection.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom, Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

The registered manager used a dependency tool to help ensure staffing levels were sufficient to meet people’s needs. People’s needs were regularly assessed and reviewed. A healthcare professional told us, “Queens Court did struggle several years ago due to high staff turnover. The current core structure has been in place for a couple of years, and the continuity and shared ideas has made a significant difference.”

Staff told us they were happy working at the home and felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the service.

New staff received a thorough induction to help ensure they were well prepared and felt confident to care for people. The induction program included a welcome and introduction to the home and people who lived there, and training the provider identified as mandatory, such as safeguarding, infection control, moving and handling, communication and health and safety.

Throughout the induction process, new staff were introduced to training specific to the needs of people using the service, such as dysphagia (dysphagia is a medical term fordifficulty swallowing), diabetes and dementia.

The new staff undertook a period of shadowing more experienced members of staff and were assessed to ensure they were ready to work unsupervised.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic.

The service was kept clean, tidy and well maintained. Care staff wore appropriate protective personal equipment (PPE) when supporting people to help protect them from cross infection. A staff member told us, “We wash our hands frequently, especially if we go in and out of an infection area. We need to put on the PPE. We maintain a clean environment and clean all touch points” and another said, “We have an IPC champion at Queens Court who supports the team. We have face to face training.”

Appropriate systems were in place in relation to infection control. The provider ensured staff had access to PPE and were trained in the use of this. The provider’s infection prevention and control policy was up to date. Information about the risk of infection was shared appropriately with people using the service and visitors. The managers and senior staff carried out audits to ensure high standards of cleanliness.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines safely and as prescribed. People’s care plans reflected their preferences about how they wanted to take their medicines and this was respected.

Nurses and senior care staff were trained in medicines administration and their competencies were checked regularly by the clinical lead. Medicines audits were undertaken weekly. A staff member told us, “Face to face medication competency is completed yearly which is combined with practice session theory. Mandatory medication training including eMAR (electronic medicines administration records) proficiency training is mandatory yearly.”

We observed one of the nurses administering medicines. We saw they followed safe procedures and displayed a confident and calm manner. They communicated with people respectfully and kindly, explaining what they were doing and providing support. Consent was obtained from each person before administration. We saw a person received their injection whilst they were eating. We discussed this with the registered manager who confirmed this was part of the person’s care plan and agreed by the GP and the person. Their care plan confirmed this.

Where people were prescribed emollients, a risk assessment was in place and regularly reviewed. There was also information on the person’s care plan for staff to refer to and understand the use of emollients and how to keep the person safe from the risk of fire. Emollients are topical moisturising treatments that are applied directly to the skin to soothe, hydrate, and protect it from dryness and irritation.

Where people were prescribed ‘as required’ (PRN) medicines, we saw PRN protocols were in place. These were clear and contained all the necessary details about the person, the prescribed medicines and how to administer these.

Medicines were stored appropriately in a locked cabinet and kept in a cool room. Temperatures were taken and recorded regularly and were within safe range.

The provider used an electronic recording system. The system highlighted if a medicine was not given within the safe time of administration, or if someone had not received their medicine safely. The registered manager undertook regular audits to ensure people were receiving their medicines as prescribed. Where errors were identified, we saw appropriate actions were taken.