Archived: Queens Care Centre

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.

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. It is situated near Maltby town centre close to local shops and amenities. On the day of our inspection there were 46 people living in the home.

There was no registered manager in place for the service. The home had a manager who was in the process of registering with the Care Quality Commission (CQC). 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.

Our last inspection at Queens Care Centre took place on 12 and 13 April 2017. The home was rated as ‘Inadequate’ and the service was therefore put in 'special measures'. Services that are in ‘special measures’ are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

At the last inspection we found the home to be in breach of six regulations and requirements notices were issued. The registered provider was also issued with a warning notice telling them urgent improvement must be made.

Following the last inspection the registered provider sent us an action plan which detailed the actions they were taking to ensure they were meeting the requirements of the Health and Social Care Act 2008 and associated Regulations.

During this inspection the service demonstrated to us that improvements had been made and the service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of ‘special measures’. We found sufficient improvements had been made to meet all regulations. Although we found areas where further improvements are needed to be made and embedded into practice to ensure these are sustained.

Risks to people were being managed effectively so that people were protected.

There was a system in place to assess staffing levels against people’s needs. This meant there were enough staff on duty at all times.

In staff files we found some small gaps in the information required to ensure people being employed were of good character.

Staff were trained to give people their medicines in a safe way. Medicines were administered, stored and recorded as per recommended guidelines.

The service was meeting the requirements of the Deprivation of Liberty Safeguards. Staff had an understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People said they enjoyed the meals provided to them and that there was plenty of choice. The service had arrangements in place to ensure people received good nutrition and hydration and we found these arrangements were followed.

There were sufficient staff to meet people's care needs and staff worked together in a friendly and supportive way. The manager supported staff to undertake their core training requirements and encouraged them to study for further qualifications.

Although staff told us they could speak to the manager at any time, a regular and planned programme of supervision and appraisal needed to be embedded into practice.

There was a warm, homely atmosphere and staff had a welcoming approach to visitors. Staff knew people as individuals and provided care in a kind and patient way.

Staff and people who used the service were mutually respectful. People were seen enjoying the company of staff and staff spoke with people in a polite and caring way.

Work had started to re-write all care plans. This was to ensure people's needs were recorded and understood by everyone.

People told us they enjoyed the programme of activities, but would like to go on outings outside the home.

The registered provider had a complaints policy and procedure. People told us they felt able to raise any concerns and were confident these would be dealt with by the managers.

There was a new manager in place who was working in partnership with other professionals to improve the quality of the service. The manager demonstrated an extremely open and responsive management style, providing a positive role model for other staff.

Systems in place to assess and monitor the quality of the service needed to be maintained and fully embedded into practice so that improvements were sustained.

Further information is in the detailed findings below.

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’

The service is required to have a registered manager. 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. At the time of this inspection we were told that the registered manager had resigned from their position a few days before. The deputy manager told us that they would be acting manager until a new manager is appointed.

Queens Care Centre is a purpose built home with accommodation situated on three floors. The home accommodates up to 67 people that requires personal care. It is situated on the outskirts of Rotherham in the village of Maltby and is close to local shops and amenities. At the time of the inspection there were 61 people living at the home.

Before this inspection we received information of concern from Rotherham council’s quality assurance monitoring officer. Concerns had been raised about the management of medication at the home. We therefore brought this comprehensive inspection forward.

Care records were not always fit for purpose. Some lacked detail, were out of date or contradictory. When care records were reviewed, the reviews did not always result in relevant changes being made to people’s care plans or risk assessments. We identified instances where care was not being provided in accordance with people’s assessed needs.

Health professionals told us that communication within the home required some improvements. They told us their instructions were not always followed which meant people’s care needs were not always met.

We found staff approached people in a kindly manner. However, most of the interactions we observed were task orientated. We observed people had to wait for assistance and staff were not always present in communal areas to ensure people’s safety. This indicated to us that there were insufficient staff deployed to meet the needs of people who used the service.

People were supported by staff that had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Staff recruitment processes were sufficiently robust however staff did not receive sufficient support and supervision. The acting manager told us they did not currently carry out annual appraisals with staff. This meant staff could not always discuss work practice and their own training and development needs.

The provider told us systems were in place to guide staff on safe administration of medicines. However, we identified these were not followed and people did not always receive their medication as prescribed. Protocols for the administration of ‘as required’ medications were not in place which meant people were not given pain relief at the times they required them. Medicines no longer required had not been disposed of as they should have been.

Risks associated with people's care had mostly been identified and plans of care were in place, however the risks associated with nutrition were not always followed. People were not always supported to eat and drink sufficient amounts to maintain a balanced diet and adequate hydration. We found the meal time experience did not meet the standards expected by the provider.

Activities in the home were infrequent. Relatives raised concerns about the lack of social stimulation.

Infection prevention and control policies were not always adhered to; therefore safe procedures were not always followed.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were in place to protect people who may not have the capacity to make decisions for themselves. However, we were told by the acting manager that they were unable to confirm who had authorised DoLS in place. We were unable to confirm renewals of authorised DoLS had taken place. Consent to care and treatment forms in the care plans we looked at had not been agreed or signed.

The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

The systems and processes in place to monitor the quality and safety of the services provided were not effective. There was a complaints procedure; however some relatives told us that they were not satisfied with the standards of care. One relative told us they were not satisfied with the personal care of their family member.

We found 6 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.

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.

The service has a registered manager who had been registered with the Care Quality Commission since August 2014. 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.

Queens Care Centre is a purpose built home with accommodation situated on three floors. The home accommodates up to 67 people that requires personal care. It is situated on the outskirts of Rotherham in the village of Maltby and is close to local shops and amenities.

The requirements of the Mental Capacity Act 2005 were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

People’s physical health was monitored as required. This included the monitoring of people’s health conditions and symptoms so appropriate referrals to health professionals could be made. We spoke with a visiting community nurse who said, “The staff acted in a timely manner to seek my advice. I think the home is well led and the care is person centred. All referrals made by the staff are appropriate.” The nurse told us that they had received a referral for a person who had been identified as a falls risk.

People were protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. Protocols were in place for administering ‘as required’ medication for pain. Some protocols that we identified as missing on the first day of the inspection had been added when we returned to complete the inspection.

There were sufficient staff with the right skills and competencies to meet the assessed needs of people living in the home. Staff were aware of people’s nutritional needs and made sure they supported people to have a healthy diet, with choices of a good variety of food and drink. People we spoke with told us they enjoyed the meals and there was always something on the menu they liked. We observed the mealtime experience on both days of this inspection and found improvements could be made.

The environment was clean and tidy. However some carpets in communal areas and corridors were showing wear and tear. The registered manager told us these areas were on the refurbishment programme to be replaced. Some areas of the home were decorated in a dementia friendly way. However, we found signage could be improved in communal areas. Dining areas required attention to make them more dementia friendly. For example display boards for menus and the date and seasons would help people living well with dementia orientate to time and place.

People were able to access activities. The activity coordinators had developed a weekly plan of activities. People could also access religious services which were held periodically at the home. We saw some of the activities available to people during the inspection. For example, flower arrangements, bingo, hairdressing and one to one pampering.

We found the service had a friendly relaxed atmosphere which felt homely. Staff approached people in a kind and caring way which encouraged people to express how and when they needed support. Everyone we spoke with told us that they felt that the staff knew them and their likes and dislikes. One person said, “I like it here the staff are kind and friendly.” Relatives also confirmed to us that they thought the staff supported people appropriately and encouraged people to be involved in their care.

Staff told us they felt supported and they could raise any concerns with the registered manager and felt that they were listened to. People told us they were aware of the complaints procedure and said staff would assist them if they needed to use it. We saw a number of complaints had been appropriately investigated in a timely manner.

There were effective systems in place to monitor and improve the quality of the service provided. We saw copies of reports produced by the registered manager and the provider. The reports included any actions required and these were checked each month to determine progress.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw people using the service were treated with respect and dignity by the staff who supported them. Care and support was delivered in a safe way by staff who were knowledgeable about people's needs.

There were systems in place to make sure people received their medications safely and we saw staff responsible for administering medication had completed training in this subject.

We saw there were enough qualified, skilled and experienced staff on duty to meet people's needs in a timely way.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

Is the service effective?

People's health and care needs were assessed on a regular basis. We were told people who used the service and their relatives had been involved in writing plans of care but the electronic system used did not demonstrate this. Care records had been reviewed and updated regularly.

Staff we spoke with felt they had received a good induction to the home and a varied training programme was available that helped them meet the needs of the people they supported.

People received a well-balanced diet and were involved in choosing what they ate. The people we spoke with said they were very happy with the meals provided. Specialist dietary needs had been assessed and catered for.

Is the service caring?

People were supported by friendly, caring and helpful staff. We saw staff interacted with people in a positive way. The people we spoke with commented positively about the care and support provided. One person said 'It's brilliant here, excellent, staff are welcoming and they treat mum, and everyone else, like she is a person.' Another person told us, 'We are very happy with the care.'

Care files contained information about people's needs and preferences. We saw care and support had been provided in accordance with people's wishes.

Satisfaction surveys and meetings had been used to enable people to share their views on the service provided. This helped the provider to assess if people were receiving the care and support they needed. People's comments indicated they were happy with how staff supported them and the home's facilities.

Is the service responsive?

Care records demonstrated that when there had been changes in people's needs outside agencies had been involved to make sure they received the correct care and support.

People who used and visited the service knew how to make a complaint if they needed to. People told us they had no concerns but said they would feel confident raising any issues with the staff.

Is the service well-led?

At the time of the inspection there was no registered manager. However, an acting manager was in post and they had submitted an application to become the registered manager at the home.

There was a quality assurance system in place to assess if the home was operating correctly. This included surveys and regular audits. We saw action plans were in place to address any shortfalls found and progress was being made to address these.

Staff were clear about their roles and responsibilities. We saw staff had access to policies and procedure to inform and guide them. Staff training and development needs had been assessed to enable the provider to arrange future training sessions.

People experienced care, treatment and support that met their needs and protected their rights. One person who used the service told us that she had just been supported to have a bath. They said 'I've just had a bath, it was like heaven, I'm all spruced up'. They also told us 'the staff do very well as they do have some awkward customers', 'I'm safe here'.

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. All staff had received training in abuse awareness and protecting vulnerable adults in the previous year. There were resources available to all staff in relation to safeguarding, including an information guide that was given to all staff to keep with them when at work.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

People were cared for in a clean, hygienic environment. We looked around the premises to determine cleanliness and management of infection control. We found there were effective systems in place to reduce the risk and spread of infection.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Before people received any care or treatment they were not routinely asked for their consent and the provider did not always record their wishes. Where people did not have the mental capacity to consent to their care, there was little evidence that the provider had taken steps to ensure appropriate decisions had been made on people's behalf about them receiving care.

People experienced care, treatment and support that met their needs and protected their rights. People told us 'they are always checking if I'm ok. Nothing's too much trouble' and 'I think my room is a good one, I can see out onto the park'

People were not cared for in a clean, hygienic environment. An inspection of the premises found that there were a number of areas that were not cleaned to an appropriate standard.

People were not cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had not completed mandatory training in nutrition, infection control, moving and handling, medication and food hygiene.

People's personal records were predominantly accurate, fit for purpose and contained sufficient detail.