Queensgate Residential Care Home

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

The previous rating for this quality statement under the old provider was requires improvement with a breach of Regulation 15 (Premises and Equipment). At this assessment we found the service continued to be in breach of Regulation 15 (Premises and Equipment). Other areas of the service had deteriorated, and we found breaches of Regulation 12 (Safe Care and Treatment), Regulation 13 (Safeguarding service users from abuse and improper treatment), and Regulation 18 (Staffing). The rating has remained requires improvement. We found no evidence during this assessment that people had been harmed. The premises and grounds, including furniture, equipment, fixtures and fittings were not well maintained putting everybody at risk from potential harm under the Health and Safety Act 2008. Staff responsible for the management and administration of medication were not suitably trained and competent and failed to follow best practice policies and procedures about managing medicines. The provider did not ensure robust processes were in place to provide staff with the information required to reasonably manage known risks to keep people safe. People told us they felt safe. However, safeguarding processes failed to ensure people were always protected from the risk of abuse and improper treatment. The provider and staff did not always understand and work within the requirements of the Mental Capacity Act 2005 to ensure all decisions for people's care and support were effectively supported and outcomes recorded. The provider did not ensure that people always received care and support from suitably trained and skilled staff putting them at risk from harm. Staff were not suitably supported due to a lack of regular planned supervision and annual appraisal.

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 had been involved in the development of their care pan prior to admission. However, we could not be assured people always received a safe admission or transition to the service. For example, some people had been admitted to the service without staff having been trained to have the knowledge and skills to safely support their specific needs.

Management at the service told us they completed a monthly analysis of accident and incidents. However, following review of this process we found further improvement was required to ensure the analysis was robustly completed as required; to keep people safe from otherwise avoidable harm.

We checked and found processes were available but not fully utilised to ensure accurate reporting was completed and evaluated with recorded outcomes, and actions used to prevent further similar incidents.

People had been involved in the development of their care pan prior to admission. However, we could not be assured people always received a safe admission and transition to the service. We found some people had been admitted to the service without staff having been trained to have the knowledge and skills to safely support their specific needs.

Management spoken with were able to provide examples of how they had supported people to transition to other new services, including sharing information to support an effective handover. However, they had not always fully considered the skills and competence of staff to meet people’s individual needs when admitting them to the service.

Visiting health professional confirmed the service had worked with them to improve referrals. A health professional said, “They are proactive in some instances; they had already got a sensor mat in for [Name]. I spent some time with [managers name] to prompt referrals as they maybe didn’t want to bother us.”

Processes to transition people into the service were used to identify and support generic activities of care and support but did not always ensure effective evaluation and planning to meet people's individual needs. For example, where people were identified with a learning disability the service did not always ensure all required resources, including suitably trained and competent staff were in place to meet all of their needs.

People told us they felt safe. However, we could not always be assured that when incidents of a safeguarding nature occurred these were always reported and acted on to ensure people were kept safe.

Staff understood how to recognise, and report concerns of a safeguarding nature. However, they did not always feel these were acted on to keep people safe. The manger told us they had a good relationship with the safeguarding team. However, they had not always recognised and acted on all allegations of abuse putting people at risk of harm.

During the inspection we found people appeared to be comfortable living at the home, and in the company of staff supporting them. We observed kind interactions between staff and people.

People were at risk from the risks associated with abuse and harm. Systems and processes to safeguard people failed to ensure management and staff had the required skills and resources to to report, escalate evaluate and learn from all allegations and incidents. For example we found some concerns raised by staff were of a safeguarding nature but these had not always been acted on with consideration of the management of the risks from harm. The application of the Mental Capacity Act 2005 had not always been applied. Where people had restrictive practices in place under the MCA, processes were not sufficiently robust to ensure effective oversight of their Deprivation of Liberty Safeguards including the management of incidents.

People told us they were happy with the support they received from staff. One person told us falls mat equipment was in place to manage their falls risks. However, we found associated management processes in place to identify all risks, including those associated with the environment failed to provide people with assurances of safety all of the time.

Systems and processes did not provide assurances of safe management of the service. The manager provided examples of how they were going to support people to take positive risks but there was no plan to put these into practice. The manager was not aware of guidance that helped to reduce and manage risks associated with the health and safety of the service. For example, they were not aware of guidance for window safety which put people at risk of harm. The management team were aware care plans and risk assessments required work, but they had not identified the concerns we found in relation to risk management.

Staff did not always demonstrate the required skills and competence when operating equipment to support people around the home. For example, whilst no harm was caused to people, we observed staff did not always apply safety breaks to equipment when supporting people to mobilise and transfer putting them at risk from injury. We observed staff were not always attentive or reactive where risks of harm were apparent. For example, we observed staff in a communal area where people were present. One person dropped a drink on themselves and on the floor. We ensured appropriate support was provided to keep people safe whilst staff present failed to promptly support the person to check this lady was not burnt. Staff who were aware of the spillage failed to acknowledge or act to remove the hazard choosing to leave the area putting other people at risk.

Records were not always accurate to ensure all risks were identified and safely managed. For example, multiple personal emergency evacuation plans had incorrect room numbers on. This meant people were at risk from unsafe evacuations during an emergency. Risk assessments for people were at times generic and not specific to the persons needs. They did not always contain information about the individual to guide staff to manage all risks. Robust care plans were not always in place to support people when they displayed emotion through behaviour. Processes were not always in place to monitor these incidents, to ensure triggers and good strategies were developed to keep people safe. When incidents had occurred, risk assessments and care plans had not always been fully evaluated or updated to ensure any existing guidance remained safe and relevant. Processes to manage risks in relation to the environment and equipment were not comprehensive or robustly implemented. For example, one person’s risk assessment detailed their wardrobe was required to be secure. However, despite further monthly checks this had not been actioned putting the person at ongoing risk of harm.

We received mixed feedback from people and their relatives regarding the environment. One relative told us, “The outside of it [the home] needs work it's not appealing and needs a bit of maintenance. It's not like a care home; there is nothing appealing, no hanging baskets or a nice space for them to spend time outside.” People’s own rooms required attention, for example, outstanding repairs to flooring and sink surrounds had not been completed.

The management team told us they had been taking steps to improve the environment and had an action plan in place. This included developing outside space. However, staff were not always fully aware of what they were checking when conducting health and safety checks around the service.

At the last inspection under the previous provider the service was in breach of regulation 15 (Premises and equipment). At this inspection, the service remained in breach of this regulation. We found some improvements had been made to the environment. For example, the decoration of communal areas. However, we observed there was still a significant amount of work to do to ensure a safe environment. Multiple bedrooms had skirting boards missing and sink surrounds were chipped down to the wood with resulting risks to peoples health and wellbeing.

Systems to ensure the environment were safe were not always robust to maintain a safe service. For example, internal checks were not in line with guidance. Window safety checks did not check the opening width of the window and windows were opening further then the guidance. Some checks had not been completed such as asbestos surveys.

People were not always supported by staff who had training to ensure they had the skills and knowledge to support them safely. One person told us staff did not always understand their health conditions. They said, “Some people definitely need to retrain as they don’t appear to know about the illness people are suffering from. No consideration is given at times to the conditions of an illness. A good example is waking me slowly and allowing me to embrace the day before giving me my medication”.

The management team used a dependency tool to assess the staffing hours against people's changing needs. This included night-time hours, but did not then calculate the night-time staffing levels. The nominated individual told us this was something they would review. The nominated individual told us they had recently increased staffing hours at peak times following staff feedback. Staff did not always feel they received adequate training. One staff told us, “We have not had any specific need training; I would like to have more training to manage people's conditions.” Another staff told us, “The training side of things is not good, the manager takes people on with no experience in care, they get 2 weeks of shadowing and are left to get on with it; it should not be like this.” We received mixed feedback on the staffing levels at the service. Some staff told us they had time to spend with people, however some staff told us, “We are normally quite rushed off our feet and unable to talk to residents, we don’t even have a chance to do our key worker duties either.” We received feedback from the nominated individual that they had sourced and booked required training for staff. They commenced a programme of competency assessments with staff during the inspection to ensure they completed activities of care and support following best practice guidance.

Observations showed that staff were on duty and available in the building. However, at times the deployment of staff needed to be reviewed to ensure peoples safety was supported and their needs always met in a timely manner.

Staff had not received sufficient training to ensure they had the required skills and knowledge to support people safely in line with their assessed needs. When people had specific health conditions, staff had not had training in these conditions. For example, 4 people were diagnosed with Parkinson’s and 3 people were diagnosed with epilepsy. Staff required training to safely support these needs. People were at risk from harm as staff on duty were not always suitably trained to keep them safe. For example, on a night shift the staff on duty had not completed fire or moving and handling training. Staff had not always completed required training but were working unsupervised with people. One person required dedicated 1:1 staff support to keep them safe. However, the staff member in this role had not completed their training and had limited experience in working in health and social care. The provider held a training matrix to record completion of mandatory and other training. However, this was not effective to ensure staff remained up to date as the matrix clearly showed gaps where this was required. The provider failed to ensure staff received scheduled checks to determine their competency in their roles and when delivering specific activities of care and support. For example to determine staff supported people safely during moving and handling activities. Staff were not well supported to carry out their roles and responsibilities, or to discuss their aspirations and raise individual concerns. Processes failed to ensure staff received appropriate, planned and confidential one to one support and annual appraisal.

People told us they were happy with the cleanliness of the service. Feedback included “The room is always clean and tidy; the cleaners are wonderful’.

Staff told us they had good availability of, and access to Personal Protective Equipment (PPE). Domestic staff told us they had sufficient cleaning products and time to keep the service clean and tidy.

Overall, the service was clean and tidy. However, some bedrooms, equipment, and furniture could not be effectively cleaned due to the repairs and/or replacements required. PPE was available around the service and staff were observed to be wearing this appropriately.

Infection prevention and control policies were in place and accessible for staff as guidance. Cleaning schedules were in place and completed for communal areas and people’s bedrooms. The provider had infection control risk assessments in place. However, we could not be assured these were routinely applied. For example, it stated staff received annual checks on their competency with this but these were not accessible during our assessment.

Staff were available and supported people with their medicines when this was needed. However, due to the associated medicine process in place to manage this activity we could not be assured people had always received their medicines as prescribed.

Although the management team told us they had processes in place for the oversight of medication, they had not always taken action when medicines had not been delivered or administered. Staff we spoke with during the inspection had an understanding of people’s medication with the exception of the administration of thickeners. Information was not clearly available for staff to administer the correct amount which put people at risk from associated avoidable harm.

Processes in place put people at risk from not receiving their medicines as prescribed due to a lack of robust management and oversight. Medicines records were not always accurate and up to date. Medication records did not always show that sufficient time was given in between medication where required and that the prescribers instructions were followed. For example, some people’s Medicine Administration Records (MAR) were not always transcribed correctly and had not been counter signed to determine they were correct. There was no effective process to safely manage and administer topical and transdermal medicines. Prescriber thickener had been administered for two people, but there was no record of administration. When medication had been missed, there had not always been prompt action to address this and make sure there was no impact to people from missing their medication. Protocols to support administration of medicines taken as and when required (PRN) were not person centred and did not contain sufficient detail in relation to variable doses. Handwritten MAR were not always double signed following best practice guidance. Staff had not received up to date training in relation to medicines management and administration. The provider could not evidence 2 staff had received medication training. These people were stopped administering medication during the inspection. Night staff were not trained to give medication. This meant there could be delay in people receiving pain relief should they request it during the night.