Archived: Queens Care Centre

Updated 19 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced comprehensive inspection of Queens Care Centre on 7 March 2018. This inspection was carried out because we had received information of concern that the quality of care provided at the home had deteriorated. This inspection was unannounced which meant no one at the service knew we were coming.

The inspection was undertaken by two adult social care inspectors, a specialist advisor, who was a qualified nurse and two experts by experience, with expertise in the care of older people. An expert by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection visit we gathered information from a number of sources. We looked at the

information received about the service from notifications sent to the Care Quality Commission by the registered provider. We also spoke with the local authority commissioners, contracts officers and safeguarding and Healthwatch (Rotherham). Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

Before this inspection we did not ask the registered provider to send us a PIR (Provider Information Return). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Throughout the inspection we also spent time in the communal areas of the home observing how staff interacted with people and supported them.

We spoke with ten people who used the service, five of their relatives, the registered provider, the home manager and seven staff members including an agency nurse, agency senior care worker, care workers and ancillary staff. We also spoke with one visiting healthcare professional.

We looked at four care plans, medicine records for nine people, staff duty rosters and records associated with the monitoring of the service, including audits.

Updated 19 July 2018

This inspection took place on 7 March 2018 and was unannounced. This means prior to the inspection people were not aware we were inspecting the service on that day.

Queens Care Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Queens Care Centre is a purpose built home with accommodation situated on three floors. The home accommodates up to 67 older people that require assistance with their personal care needs. On the day of our inspection there were 35 people living in the home.

We carried out an unannounced comprehensive inspection of this service on 15 November 2017. At that inspection the home was rated as Requires Improvement. After that inspection we received concerns in relation to the standard of care people were receiving. As a result we undertook a further comprehensive inspection to look into those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Queens Care Centre on our website at www.cqc.org.uk.

There was no registered manager in place for the service. The service had not had a registered manager since June 2017. A registered manager is a person who has registered with CQC 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.

The service had an unstable workforce. The majority of permanent staff had either left or been dismissed from the service since our last inspection, which included the home manager. There was a high use of temporary staff from an external agency to fill senior care worker and care worker shifts. This meant staff were not familiar with the personal needs and requirements of people who used the service. This had resulted in people not being provided with safe care and treatment.

There had been no formal assessments of whether staff were deployed effectively and in sufficient numbers to meet people’s needs, and we observed incidents where people were asking for staff assistance but none was available. Staff described incidents where they could not meet people’s needs due to low staffing numbers.

We found people were not fully protected against the risks associated with medicines because the registered provider and manager did not have appropriate arrangements in place to manage medicines. Also records for the administration of medicines were not fully completed by staff.

There was not a system in place to identify and assess risks associated with the health, safety and welfare of people who used the service. Appropriate and timely actions had not been taken by staff to prevent people from being put at risk or coming to harm. Also the management of accidents and incidents was not helping to ensure people were kept safe.

People at the service were not always actively supported to maintain good health. The advice provided by visiting healthcare professionals was not always acted upon so that the health and welfare of people was maintained and improved.

People spoken with told us in the main they were happy with the quality of the food provided. We found people’s mealtime experience differed greatly. The interaction between the care staff and people living at Queens Care Centre was variable with some people not being supported adequately to maintain a healthy diet.

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; the policies and systems in the service did not support this practice. This was because some people’s freedom of movement was being unlawfully restricted.

People who used the service and their relatives gave us some positive feedback about the ‘regular’ staff and said they were kind and caring. People were not as complementary about many of the agency staff who were working in the home due to so many permanent staff leaving their role.

Staff were observed to undertake care tasks without engaging with people, and did not uphold people’s privacy or dignity. Staff did not communicate with people effectively, which had a negative impact on people who used the service.

Care was not always tailored to meet people’s changing needs. The reviews of care and support were not effective as they didn’t affect the required changes. We identified there were occasions where the staff had failed to act in accordance with the direction of external healthcare professionals. This meant appropriate care was not provided in a person centred way in order to meet people’s needs and have regard for their well-being.

Arrangements at the home for monitoring the care provided, and ensuring it was of high quality, were inadequate. The registered provider and manager could not evidence that any formal auditing of care delivery had been completed since November 2017. As a result, care records and care delivery was inadequate. The registered provider had failed to identify shortfalls across the whole scope of the service delivered.

We found six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we 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 are added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures.’

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.