Archived: Living Plus Healthcare Ltd t/a Queen Anne Lodge

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.

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 22 people using the service.

People’s experience of using this service and what we found

At this inspection we found five breaches of regulation and four of these breaches were continued from our previous inspection in 2019. The provider had submitted an action plan following the last inspection but had failed to make or sustain improvements in these areas and a further breach was identified. Whilst people and their relatives told us people received a good standard of care which met their needs safely, we continued to find governance was not well-embedded into the running of the service and the framework of accountability to monitor performance and risk was not always effective.

People and relatives told us the service provided safe care. However, we continued to find risks to people had not always been assessed, monitored or evaluated. Risks to people from the premises and equipment were not always safely managed and the provider has been advised to make improvements for people’s safety by the Fire and Rescue Service. People’s medicines were not always safely managed. Some improvements were required in the prevention and control of infection and we have made a recommendation about this. We did not find people had been harmed and the registered manager acted promptly to address these concerns during and following the inspection.

Since our last inspection the provider had acted on our recommendation and made improvements regarding acting on safeguarding incidents and learning from safety related concerns. There were enough staff to support people safely.

People, who were able to, told us they were involved in decisions about their care. People’s relatives told us they were consulted and informed about how their relatives care needs were met. However, we continued to find decisions made about people’s care and treatment were not always underpinned by evidence to demonstrate the principles of the Mental Capacity Act (2005) had been applied. This meant people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the systems in the service did not support this in practice. Following our inspection, the registered manager and provider’s consultant assured us they were acting on these concerns.

We continued to find people’s needs were not always assessed in a timely manner to provide guidance for staff delivering their care. Following our recommendation improvements had been made in the induction training for staff new to care. However, the training required by the provider had not been completed by all staff, this included training to meet people’s healthcare and safety needs. Improvements had been made in the management of people’s nutrition and hydration needs and people’s weights were monitored for changes. However, the monitoring, evaluation and actions to mitigate risks in this area still required improvement. We have made a continued recommendation about this. People and their relatives spoke positively about the food and choice of food available. Advice and guidance were sought from healthcare professional as and when people required this, and regular healthcare meetings were held to review progress. People’s oral healthcare needs were monitored and met.

People and relatives told us they were supported by caring staff who were compassionate, patient and kind. People were treated with dignity and respect and told us staff listened to them and acted on their preferences and choices.

People and relatives told us the service met their (or relatives) needs. Records to support the delivery of person-centred care were still not always up to date, accurate or complete. Although staff we spoke with knew people well this is important to ensure guidance is available for all staff to follow. End of life care plans had not always been fully completed. Records did not always demonstrate people’s preferences had been explored in respect of their end of life wishes. We had made a recommendation about this in our previous report. The registered manager has taken action to improve people’s records to support person centred care. The provider had improved their implementation of the Accessible Information Standard to support people’s communication needs.

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 13 August 2019) 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.

At our last inspection we recommended the provider sought advice about the management of safety concerns, guidance on induction and training standards for care workers, the management of people’s nutrition and hydration needs, consent for the use of surveillance equipment, end of life care practice and the Accessible Information Standard and updated their practice accordingly. At this inspection we found the provider had acted on some of the recommendations, but others had not been improved and fully embedded into the service.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about cleanliness, risk management, care planning and staffing. A decision was made for us to inspect and examine those risks. We have found evidence the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report. You can see what action we have asked the provider to take at the end of this full report

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 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 and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to; safe care and treatment, person centred care, the need for consent, governance and staffing at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Living Plus Healthcare Ltd, trading as Queen Anne Lodge, is a residential care home providing personal and nursing care to 34 people aged 65 and over, including people living with dementia at the time of the inspection. The service can support up to 40 people.

People’s experience of using this service and what we found

Systems and processes in place to assess and manage risks to people were not always completed in a timely or thorough manner. Whist we did not find evidence that people had been harmed, this meant people could be at risk of unsafe care and treatment. The service needed to improve their response to concerns to ensure lessons were learnt to prevent a reoccurrence. We have made a recommendation about this. People’s medicines were managed safely, and the environment was clean which reduced the risks from the spread of infection.

Peoples needs were not always assessed in a timely manner or delivered in line with legislation and best practice to guide staff delivering care. People were not always 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 were not always followed in this respect. Staff training was not all up to date; however, training was planned. The induction of new staff did not meet current best practice guidance. The management of people’s nutritional needs required improvement and we have made recommendations about these issues. The environment was being adapted to meet people’s needs more effectively and people were supported with their healthcare needs.

People’s care records were not always accurate and up to date. Whilst we found staff were aware of people’s needs and people told us they received the care they needed, the lack of up to date person centred guidance could put people at risk of inappropriate care and treatment. Improvements were required in the assessment and care planning of people's communication and end of life care needs. We have made recommendations about these areas. People told us they enjoyed the activities available at the home which were based on people’s interests and preferences. Complaints were responded to in line with policy and procedure.

The service was not always well-led, the systems in place to monitor, assess and improve the quality and safety of the service were not effective. The leadership and accountability arrangements at the service were not clear and actions for improvements were not effectively monitored for completion. Staff and people spoke positively about the culture in the service and were invited to give feedback to the provider. The service worked with other agencies to promote positive outcomes for people.

People were supported by caring, kind and compassionate staff. Staff respected people’s decisions and people told us their privacy, dignity and independence were respected. The service used CCTV in communal areas and we have made a recommendation about this in terms of people’s consent to its use.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: This last rating for this service was good (Published 5 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, the need for consent, good governance and person-centred care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out a focused inspection of this service on 9 May 2016 to follow up the warning notices we had served on the registered provider. At this inspection we found the home to be compliant with these Regulations although further work was required to embed this work.

We carried out a comprehensive inspection of this service on 5 and 6 October 2016 and found the registered provider was now compliant with all the Regulations. The home has been removed from special measures following this inspection.

The home provides accommodation, support and care, including nursing care for up to 40 older people, some of whom live with dementia. Accommodation is arranged over three floors with stair and lift access to all floors. At the time of our inspection 37 people lived at the home.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Processes were in place to check the suitability of staff to work with people. There were sufficient staff available to meet the needs of people and they received appropriate training and support to ensure people were cared for in line with their needs and preferences.

Medicines were administered, stored and ordered in a safe and effective way.

Risk assessments in place informed plans of care for people to ensure their safety and welfare, and staff had a good awareness of these. External health and social care professionals were involved in the care of people and care plans reflected this.

People were encouraged and supported to make decisions about their care and welfare. Where people were unable to consent to their care the provider was guided by the Mental Capacity Act 2005. Where people were legally deprived of their liberty to ensure their safety, appropriate guidance had been followed.

People received nutritious meals in line with their needs and preferences. Those who required specific dietary requirements for a health need were supported to manage these.

People’s privacy and dignity was maintained and staff were caring and considerate as they supported people. Staff involved people and their relatives in the planning of their care. The home used closed circuit television to promote the privacy, dignity and safety of people. There were appropriate policies and procedures in place relating to this.

Care plans in place for people reflected their identified needs and the associated risks. Staff were caring and compassionate and knew people in the home very well.

Effective systems were in place to monitor and evaluate any concerns or complaints received and to ensure learning outcomes or improvements were identified from these. Staff encouraged people and their relatives to share their concerns and experiences with them.

The service had effective leadership which provided good support, guidance and stability for people, staff and their relatives. People and their relatives spoke highly of the registered manager and their team of staff.

Following this comprehensive inspection we served two warning notices with respect to these breaches, on the registered provider of the service and the registered manager, requiring them to be compliant with the Regulations by 18 January 2016.

We undertook this unannounced focused inspection on the 9 May 2016 to check they had met the legal requirements and made necessary improvements in relation to the safe and well led questions. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Living Plus Healthcare Limited t/a Queen Anne Lodge on our website at www.cqc.org.uk

The home provides accommodation and nursing care for up to 40 older people including those living with dementia. At the time of our inspection 40 people lived at the home.

At the time of the focussed inspection a registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found improvements had been made, although further embedding was needed.

Knowledge of people and the risks associated with their care was good. Staff knew the support people required to reduce risks. Most areas of identified need that presented a risk had a plan developed to inform staff of what to look for and how to provide support. However, there were occasions when the care did not meet these plans.

Records had improved since the last inspection, although they were at times long and not all information was kept in a single place making it difficult to track.

Staff said they felt supported by the registered manager and said that this had improved since our last inspection. They said they felt listened to and able to approach the registered manager with any concerns they had. They said they felt the registered manager listened and would take action to address any concerns.

Feedback about the provider was mixed. Improvements had been made to the systems used to assess quality however, further improvements were required to ensure these were fully effective and embedded. We have made a recommendation about this.

We found that people received personalised care, treatment and support. The service worked in cooperation with other providers to ensure people who had dementia had their health and care needs met.

There was an effective system in place to ensure that the service was monitored effectively. We saw that appropriate action was taken when assessments identified changes or improvements needed to be made to the service.