Queens Court

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Systems and processes in place were not effective in identifying and managing and notifying of safeguarding concerns. This was a breach of Regulation 18 (Registration) Regulations 2009, Notification of other incidents. Health professionals visited the home to support people with health care needs, and they were happy with how staff worked with them and supported people with care. There was a failure to notify the local authority safeguarding team, and CQC of an incident with a person living at the home. This was a breach of Regulation 13 Health and Social Care Act 2008, Regulated Activites, Regulation 2014. Safeguarding service users from abuse and improper treatment. We found people's consent was not always sought with the planning of their care and support needs. This was a breach of Regulation 11, Health and Social Care Act, Regulation 2014, Need for consent. Medicine audits did not identify issues found with how to manage people's risks with medication in relation to blood sugar. This was a breach of Regulation 12, of the Health and Social Care Act 2008, (Regulated Activities) Regulations 2014.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People who used the service could not always communicate their views with us. We received no comments from people about learning culture.

The registered manager failed to raise a safeguarding concern with the local authority following an incident where a person sustained an injury after leaving the service. CQC were also not informed of the incident which the registered manager was required to do. This was discussed with the registered manager, who told us they had made appropriate changes within the service, ensuring the safety of the person. The registered manager told us they were always open and transparent with family members and professionals when things went wrong.

The providers systems and processes in place were not effective in identifying and managing safeguarding concerns, complaints and learning from incidents. Records showed that safeguarding concerns were not always correctly identified, assessed, and responded to in line with the duty of candour, the providers policy and best practice. There was no safeguarding file in place to ensure records were maintained and no motoring or auditing tools in place to oversee and learn from safeguarding concerns and incidents. This was a breach of Regulation 18 (Registration) notification of other incidents.

People told us they had access to health care professionals when they needed them. However, records showed that staff communication and referrals to health and social care professionals were not always effective or made in a timely manner.

The registered manager told us they worked with various professional teams to support people with their care needs. These included physiotherapists and speech and language therapists. The community mental health team attended the service to review people’s care and support needs on a regular basis. A GP visited the service each fortnight to support people with their medical needs. The deputy manager told us the service had positive links with community services including district nurses, and community mental health teams. They described how the community mental health team provided positive advice and support for people who may present with distressed behaviour and help the home to develop strategies to support individuals with their needs.

A visiting GP told us they attended the service fortnightly. In between visits, staff could arrange for the practice nurse to review people needing an emergency appointment. They said staff and managers managed the people’s medical needs well. The GP told us the activity coordinator had a very positive impact on people using the service. A visiting professional told us staff knew people well and always had the appropriate records ready for them when they attended the service. They said staff were competent and followed any advice they gave them. They had some concerns about wound care and management at the service. They told us they would raise this with the manager during their visit and their manager when they returned to their office. Another visiting professional told us that a person’s family had just commented to them that their loved one was beautifully cared for.

Staff worked in partnership with GP’s and other health and social care professionals to ensure people had access to care support when they needed it. The service had made referrals to these professionals, but we found staff had not always followed up on the referrals in a timely manner when people’s support needs had changed. This put people at risk of receiving inappropriate care for their changing needs. The contact details for external healthcare professionals such as speech and language and occupational therapists were held in people's care records. However, we found that some records were not accessible for people who received support from community nursing teams. This put people at avoidable risk of having appropriate care and support delayed.

People told us they felt safe living at the home. One person said, “They [staff] have been really helpful to me.” Another person commented, “I have not been here long, but they [staff] are supportive to my needs.” Comments from visiting relatives relating to their [loved one’s] safety within the service was mixed. One relative said, “I don’t feel [my loved one] is safe when I leave here, which concerns me”, and “I don’t feel like [my loved one] is safe here.” However, we also received positive comments from visiting relatives like, “I’m glad I picked this home because [my loved one] is safe here.”, and “There is always staff near [my loved one’s] room.”

The registered manager told us they did not have a safeguarding adults or complaints log in place. The deputy manager told us they had a meeting recently with the registered manager and they were working to develop tools for the monitoring and reviewing of safeguarding adults, complaints and accidents and incidents. The registered manager and deputy manager told us they were aware of their responsibility to report allegations of abuse and how to refer to the local authority safeguarding team and CQC where required. Staff told us they had received training and regular refresher training on safeguarding adults from abuse. They told us they would report safeguarding concerns to the registered manager.

We saw there were no safeguarding files in place to ensure records were maintained. We saw no monitoring or auditing tools in place to oversee and learn from the safeguarding concerns that and incidents that occurred. Records showed that safeguarding concerns were not always correctly identified, assessed, and respond to in line with the providers policy and best practice. We saw for one incident involving the safety of a person who had left the service and sustained an injury, appropriate actions had not been identified and taken by the registered manager. We discussed this with the registered manager who confirmed to us they had ensured the safety of the person and made appropriate changes to the home environment. The registered manager had failed to refer the concern to the local authority or raise a safeguarding and had failed to notify CQC as required. This was a breach of Regulation 13: Safeguarding service users from abuse and improper treatment.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether any restrictions on people’s liberty had been authorised and whether any conditions on such authorisations were being met. We found care plans for some people with dementia lacked an MCA, or detail of how people should be supported by staff. Therefore we were not assured staff were working in people’s best interests. We discussed this with the registered manager who told us they would address these concerns. People’s consent was not always sought when planning for their care and support needs. This was a breach of Regulation 11 HSCA RA Regulations 2014 Need for consent. There were safeguarding and whistleblowing policies and procedures in place. The staff we spoke with were aware of the different types of abuse and knew how to report concerns. Staff told us they were aware of seeking consent from the people they supported, and they had received MCA training. People’s rights were sometimes protected as staff sought people’s consent before supporting them.

We received mixed feedback on whether people thought they were involved in the planning of their risk and support needs. We received the following comments from relatives, “I have asked for help with understanding the care of my loved one, but I have not received any information.”, and “They don’t ask my loved one about their life, my loved one is always willing to talk if they tried.” One person told us, “I wish they had more information on my situation.” Another person said, “I was asked some questions when I came here.”

After our first site visit at the service, we were informed of a serious incident that had involved a person living at the service. On our second site visit we spoke with the registered provider and staff about how they had responded to the serious incident and supported people with their care needs and risks. The registered provider told us they had offered further training for staff in managing specific risks to people. We spoke with 5 staff who told us the training they had received was helpful. They all described in detail how they would support people with their needs and specific risks. One staff member told us the training included video’s, demonstrations and role play During this assessment, we were informed of a serious incident which involved a person living at the home. We spoke to the provider and staff about the response to this incident, and how people were supported with their care risks and needs in relation to this. The provider told us they had offered staff further training in managing specific risks to people. We spoke with 5 staff members who told us the training they had received was helpful. They were all able to describe in detail how they would support people with their needs around specific risks. One staff member told us the training included video’s, demonstrations and role play.

The provider failed to ensure there were effective systems in place to manage risks to people using the service.

We looked at 18 peoples care records. Risks to people were not always identified, assessed, documented, and reviewed to ensure their safety and well-being. Risk assessments did not always provide appropriate guidance for staff on risks and how best to support people with their needs. Information within people’s care records was contradictory and not reflective of their needs and risks. Examples of our findings included one person’s mobility assessment stated they were at very high risk of falls. However, there was no details or guidance for staff to follow to ensure the person’s safety. Another person’s mobility assessment recorded they were at risk of falls. They required 1-1 supervision while walking and did not need to be reminded to use their mobility aid. There were no details provided on what the mobility aid was, or any other equipment needed to ensure their safe mobility. Another person’s diabetic care plan recorded they were Type II diabetic; their diabetes was medication controlled. However, their medicine care plan stated they had Type 2 diabetes which was ‘diet controlled.’ A fourth person, without capacity to do so safely, was at high risk of leaving the service. However, the deputy manager told us there was no care plan in place to advise staff on the prevention of the person leaving the service and the support the person required to maintain a safe environment. The provider failed to ensure there were effective systems in place to manage risks to people using the service. These issues are in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who used the service could not always communicate their views with us. People did not make any comments about the environment.

The registered manager told us there were plans in place to provide a dementia-inclusive environment for people using the service. People’s rooms had been furnished according to their wishes.

In the home, the décor was dated and tired in parts. There was new wood flooring, which was shiny and could pose a slip hazard putting people at risk of avoidable harm. When we arrived at the service, there was a slight malodour, however domestic staff rectified this by following through their cleaning schedule. People’s rooms had their name and picture displayed on the doors, however, there were no memory boxes in place to aid orientation. We observed that all parts of the home were kept clean. Pathways were clear of trip hazards. There was a secure garden at the back of the service with suitable furniture that people could enjoy in warm weather.

We saw the service had regular checks and audits in place which to keep the service safe. We saw a copy of the fire risk assessment, and servicing certificates for the fire alarm system, and records of fire drills. We saw servicing certificates to support audits and checks on portable appliances, gas safety and legionella testing were all completed and up to date. Other checks included water temperature and call bell checks and audits.

People told us there were enough staff to meet their needs. One person said, “There are always staff available if I need help.” Another person told us, “There are loads of staff all the time, if I need something there is always somebody.”

The registered manager showed us a staffing rota and told us staffing levels were arranged according to the needs of the people using the service. Staff told us about a two-day dementia course which they found very useful and helped them understand the needs of the residents who may present with distressed behaviour or with a different reality dur to their dementia. However, staff training records showed that some staff were not always up to date with required learning. For example, 3 staff members had not completed their first aid refresher training when required. However, staff training records showed that some staff were not always up to date with required learning. For example, 3 staff members had not completed a first aid refresher training as required.

The provider failed to ensure there were effective systems in place to manage risks to people using the service.

Robust recruitment procedures were in place. Recruitment records included completed application forms, employment references, health declarations, proof of identification and evidence that a Disclosure and Barring Service (DBS) check had been carried out. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. We saw the provider's training matrix. Training records showed that some staff were not always up to date with required learning. This included training in areas such as food hygiene, oral care, dementia awareness, moving and handling, fire safety, first aid, diabetes, equality and diversity, health and safety, medicines and falls.

We observed that communal areas and people’s bedrooms were kept clean and tidy. However, some areas of the home appeared dated and run down.

The registered manager told us there were 2 housekeeping staff employed. Between them they kept the service clean 7 days a week. Cleaning schedules confirmed this.

We observed some parts of the service appeared tired and in need of redecoration, however the service was clean and well maintained. We were told there were plans underway to make improvements to the environment.

The provider had an up-to-date infection prevention and control policy in place. Housekeeping staff used a cleaning schedule to ensure that all parts of the service were kept clean and free from potential infections. Infection prevention and control audits were carried out. The service acted on the recommendations from a recent infection prevention and control audit which included making sure anti-bacterial hand gel was available.

Care plans and risk assessments did not always safely identify, assess and document people’s needs in relation to their medical requirements, however, people did receive their medicines as prescribed by health care professionals.

We saw some people had pain medication documented as PRN 'as the need arises' however, these medicines had been given to people daily. We raised this issue with a GP who was visiting the service. The GP agreed to review the use of PRN with the registered manager. The registered manager told us they would discuss PRN medicines with the GP and would also refer to the community mental health teams to review PRN use of any sedative medication. Staff told us they received training and competency assessments on the administration of medicines.

There were processes in place to support the management of medicines. However, there were areas requiring improvement. We saw a person’s diabetic risk assessment in place. However, this lacked detail of how to manage and monitor blood sugars or inform of the risk of fluctuating blood sugar. The lack of guidance for staff to follow put people at the risk of avoidable harm. Medicines were ordered and stored correctly. Regular medicine audits which were carried out highlighting areas for improvement. However, the checks and audits had failed to identify the concerns we found at the assessment. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.