Queensgate Residential Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

The previous rating for this key question under the old provider was good. At this assessment we found the rating had deteriorated to requires improvement. People told us they had been involved in their care planning. However, staff told us the service was not always effective because they hadn’t read care plans and due to a lack of support and training didn’t have all the required skills and competencies to meet people’s individual needs. Care records were not comprehensive, and information was not easily accessible, up to date or relevant. Capacity assessments and best interests had not always been carried out. Applications to deprive people of the liberty had been submitted, but conditions had not always been acted on.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they had been involved in discussions to plan their care. However, staff required further training to ensure they had the appropriate skills and training to meet individual identified needs.

Staff told us they did not always know how to meet everyone's individual assessed needs and would welcome additional training to provide people with the best care and support. Staff told us they did not always read people's care plans to ensure they had up to date information. One staff member said, “I have never read the care plans; [senior] staff will tell us when we are on shift about any changes [in people's needs].”

People’s communication needs were recorded, but there was a lack of detail for staff to follow to meet those needs to ensure people had access to information in a way they could understand and respond to. The provider had developed care plans based on people's assessed needs. However, care records did not include all the required information in a consistent format to ensure people's changing needs were always safely responded to. For example, some people’s care plans stated a requirement for staff to weigh the person each week but there were no records to support the outcomes and monitoring of these checks, putting people at risk.

Staff offered people a choice of food and drinks throughout the day and there was food and drink available at the 'snacks and hydration' tables for people to help themselves to. We received mixed feedback from people regarding meal time arrangements. One person told us, "Food can be good, but sometimes it is very poor, particularly in the evening. Sandwich interpretation varies day by day and the time between meals is too short because you don’t get time to digest your meals before they’re serving the next."

Staff told us, and we observed people were offered a choice of food and drink. Staff recognised when people wanted alternative choices and ensured these were offered. However, staff were not always fully aware of people’s recorded hydration needs putting them at risk. For example, where people required thickeners, (used to thicken liquids to various consistencies to help people who have swallowing difficulties), staff were not aware of how much thickener people required in their drinks.

People had dehydration assessments in place, but these were not followed and acted on. Records in relation to people’s hydration needs were not fully completed and there was no oversight to ensure required actions were taken within reasonable timescales; putting people's health and wellbeing at risk. Although we saw people having regular fluid intake, one person had a recorded fluid target but this was not reached for 9 consecutive days. There was no record of required action taken.

People told us they were supported to access external services which included health care when required. However, advice following on from external input was not always recorded or promptly acted on.

We received mixed feedback from staff regarding how the staff team worked together. Staff gave examples of where important information was not shared. Staff and the management team confirmed communication needed to improve at the service.

Health professionals, told us staff were available on their visits and that they had good insight of people needs who lived at the home. However, another health professional told us, " When I have visited, I felt the care I had observed was compassionate and that staff care about the service users. Many of the service users spend time in the large communal lounge. However, when I visit service users upstairs, I do sometimes feel that it is sparse of staff and do not know how quickly they would be able to respond [to people's immediate needs].

Handover records at each change of shift were completed with details of people's changing needs. However, information shared was not always completed. For example, information following telephone calls, visitors and malfunctions was not robustly available to effectively support staff. Care plans did not always contain the most up to date guidance about how to implement recommendations following visits from healthcare professionals.

People and their relatives provided examples of how they were supported to stay healthy and staff had sought health care for people when needed. One relative told us, “Mum had a urine infection, and they contacted the doctor for mum."

Staff told us if people become unwell, they would support people to access health care services including doctors. They told us they supported people to live healthier lives. For example, by encouraging healthy options and promoting people to go outside to enjoy the sunlshine.

People were supported to access doctors and other health professionals when needed.

Most of the people who we spoke with told s they were happy with their care, but some people gave examples of outcomes that could be improved if staff had more knowledge about their individual needs. Records were not robustly recorded to provide assurances people had been given the opportunity to discuss their goals and aspirations or how these were supported.

The management team told us they had tools available to monitor people's needs. However, staff were not fully aware of these tools which were therefore not always used in practice to support people.

Monitoring tools were not consistently completed to ensure effective monitoring to improve outcomes for people. This included a lack of comprehensive and continual monitoring to support people to manage their behaviours, epilepsy, and hydration records. Care plans did not always contain enough information to improve people's outcomes. Although care plans recorded the expected objective and outcome, there was no effective way of reviewing and measuring these goals.

People had not always been supported to give their consent to their care and support or to sign consent forms. It was unclear from records to determine if people had the mental capacity to understand what they were consenting to.

Staff told us they spoke with people to obtain their agreement and consent before providing people with support. However, the management team did not fully understand required decision making processes under the Mental Capacity Act 2005 (MCA) or how to apply the Act. Staff told us they were supporting people to sign consent forms when they lacked required capacity to make informed decisions.

Processes to ensure legally authorised restrictive practice and decision making were not always effective or completed with due regard of the MCA. Capacity assessments and best interest decisions on behalf of people who had been assessed under the MCA had not always been completed. Applications to deprive people of the liberty under the Act had been submitted, but associated conditions with the approved restrictive practices had not always been acted on.