Queensgate Residential Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

The previous rating for this quality statement under the old provider was requires improvement with a breach of Regulation 17 (Good Governance). At this assessment the rating remained requires improvement and the provider continued to be in breach of Regulation 17 (Good Governance). We found no evidence that people had been harmed. The service did not have a registered manager. However, they had recruited a manager who told us they had plans to register with CQC. The management team needed further time to develop their knowledge and experience in leading the service. The nominated individual supported the service and increased their time at the service following the concerns raised during the assessment process. A range of service checks including audits were available but failed to record with outcomes and actions the concerns we identified during our inspection. Oversight to ensure feedback was captured and actioned failed to support required service improvement. Analysis of information to identify themes and trends for the benefit of people required improvement. Where concerns, incidents, and accidents were recorded there was minimum evidence of lessons learnt or sharing of required actions with staff to prevent re-occurrence keeping people safe. Checks to safely maintain and improve the health and safety of people and the environment required improvement with the addition of timescales, actions and outcomes commensurate with the level of risk.

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.

Some staff were positive about the culture of the service and told us it was a nice place to work. Staff told us they felt there were improvements to be made and that they did not always feel listened to. Some staff did not feel part of the team. Not all staff were aware of the values of the service, but they told us they believed in the benefits of delivering person centred care. The management team told us there had been improvements in the culture of the service and it appeared a happier place to work, where families seemed happier.

Team meetings were held but along with a lack of structured staff supervision failed to promote and discuss essential organisational values.

We received mixed feedback from staff regarding the effectiveness of management support. Some staff felt the manager was supportive and approachable, others felt that they were not always treated fairly and that communication with the management needed to improve.

The service did not have a manager who was registered with the CQC as required. However, they had recruited a manager who told us they had plans to register with CQC. The management team needed further time and support to develop their knowledge and experience in leading the service. The nominated individual supported the service and increased their time at the service following the concerns raised during the inspection.

Not all staff felt confident to speak up. Some staff told us when they had raised some concerns or feedback action had not always been taken. We raised this with the nominated individual who assured us this would be addressed. The nominated individual told us they had systems in place to protect people who wanted to speak up and would protect peoples confidentiality.

Whistleblowing policies were in place and leaflets were available to support staff in raising their concerns. However, further development and support was required to ensure this process remained effective in support of all staff raising concerns for independent scrutiny and response.

Some staff told us they felt well supported and part of a team where others felt not all staff were treated the same. Staff gave examples of where they had been individually supported providing flexibility in their roles. For example, they told us managers were flexible with rotas which helped support individual staff preferences and commitments. The manager told us they had an open-door policy and welcomed feedback from everybody.

The provider had policies and procedures in place to provide guidance and support workforce equality, diversity and inclusion.

Processes were in place to manage incidents and receive feedback. However, the management team had not always learnt from previous incidents or feedback and did not ensure information was used to maintain and improve standards of service. The nominated individual was responsive, open, and honest throughout the inspection. They recognised improvements were needed and responded positively to feedback given. Following the inspection, they increased the amount of time they were spending at the service in recognition of our feedback.

The provider lead governance systems that were in place were not effective. They did not identify the areas of concerns which we found at this inspection. Where concerns were recorded, action plans failed to drive the required improvements forward within reasonable timescales that were commensurate with the level of identified risks. This included concerns in relation to staffing, the environment, risk management, care records, activities, and the Mental Capacity Act 2005 including oversight of the Deprivation of Liberty Safeguards. The provider was found to be in breach of multiple regulations.   Feedback gathered had not always been used to make improvements to the service despite actions recorded. This included feedback from staff satisfaction surveys such as improvements in staff training, supervisions and activities. The provider did not robustly monitor the safety of the service, the home environment, and required equipment. The provider did not keep accurate, up to date, and contemporaneous records. This included people’s health care, care plans and risk assessments.

Whilst the service worked with other organisations and people had access to health professionals, we found there were some inconsistencies. We found referrals were made, but it was not clear from processes in place if resulting feedback was implemented to improve people’s care and support.

The manager told us they worked in partnership with other services. This included other care homes to ensure smooth transitions for people moving into the home and for people moving on from the service.

One health professional told us, "I feel there is not a clear management structure which inevitably puts more pressure on the manager to try and manage everything. Some of the tasks could be delegated to others to make the service more effective." Other health professionals had noted they had started to see some improvements at the service.

The service worked in partnership with health and social care professionals, but we found records were not always sufficiently robust, and at times we could not see action taken or if advice given had been implemented for the benefit of the people involved. 

At the time of our inspection, there was a lack of innovation at the service due to a required focus on improving the day to day quality of care and support provided. Manager's shared with us examples of how they were trying to improve and develop the service for people. Examples included the installation of a new modern nurse call system and the introduction of fall sensor mats that linked into this new system to alert staff where people who were at risk from falls required support to mobilise.

Processes in place required review and update to ensure required learning from incidents were effective to prevent repeat similar events. For example, poor medicine management continued despite the providers audit and resulting action plan, implemented following multiple identified medicines concerns.