1 March 2017
During a routine inspection
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (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.
At the last inspection we found that there were not always sufficient numbers of suitable staff available to meet people’s needs consistently across all areas of the home. At this inspection we found that staff were not effectively deployed across the home to meet people`s needs effectively and people`s dependencies were not correctly calculated to ensure these were reflected in staffing numbers. Safe and effective recruitment practices were followed to make sure that staff were of good character and had the experience and qualifications necessary for the roles they performed.
Staff were knowledgeable about the risks of potential abuse and knew how to report any concerns they had internally and externally to local safeguarding authorities. Risk assessments were in place to give staff guidance in how to mitigate risks to people`s well-being, however these were not always followed by staff in relation to pressure management and choking risk.
People who lived at the home and their relatives were positive about the skills and abilities of permanent care staff. However they were not as confident in the abilities and skills of the agency staff working at the home. Staff were trained and they felt supported by the management team at the home.
At the last inspection we found that food and fluid records were completed retrospectively, and where people needed their intake monitored, food records did not document the amount people had eaten. We found that this practice had not improved and staff who completed these records were not always the staff who supported people to eat and drink.
Queensway House has had a consistent registered manager, deputy manager and team leaders in post for a long period of time. In this inspection we found that the management team were not effective in Queensway House to implement and monitor the requirements from the inspection we carried out on 14 September 2016.
The standard of cleanliness in the home had improved. Some areas of the home were freshly decorated and there were no unpleasant odours around the home. However we found that the equipment used by staff to assist people with their mobility like hoist and rota stand was not as clean as it should have been.
Most relatives and care staff told us they had been involved, to varying degrees, in the planning of the care and support their family members received when they moved in the home. However, some people could not recall having been involved and their consent was not always accurately reflected in their individual plans of care.
People were cared for in a kind and compassionate way by permanent staff who knew them well and were familiar with their individual needs, preferences and personal circumstances. We saw that most permanent staff members had developed positive and caring relationships with people who lived at the home. They provided care and support in a respectful way, however in many cases people`s dignity was not upheld, their clothes were stained, they had no socks on and their footwear had dried food stains. Staff were not always attentive to clean people`s face and mouth after they assisted them to eat.
People were able to decide how they wanted to spend their days. We saw people on the ground floor engaged in activities around the home, reading newspapers, listening to music and chatting with each other. However people living on the first floor whose dementia was more advanced had little access to other parts of the home.
The system of meetings was not effectively led by the registered manager who was not able to maintain an oversight of the issues within their own home
The registered manager was supported by the provider, the regional manager, the hospitality manager and a dementia manager to implement and sustain improvements to the quality of the care people received in Queensway House. In addition there was support from the local authority, home improvement nurse and the district nurse team to ensure the care and support people received met their health and social needs. However the registered manager failed to ensure that the improvements needed were successfully implemented and sustained.
People’s medicines were not always managed safely. Medicine records were not completed accurately and not always signed by staff when they administered people`s medicines. When we reconciled medicines for people we found that the amount of tablets had not always corresponded with the amount on the medicine administration record (MAR).
At this inspection we found the service to be in breach of Regulations 8, 12, 10, 11, 18 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the back of the full version of the report.