Archived: Queens Court

Queens Court is a care home with nursing that is based in Windsor, Berkshire. Queens Court is one of eight care home services the provider currently operates. The service is registered to provide residential and nursing care for up to 62 people. The service is for older adults, some of whom have dementia. At the time of our inspection, 46 people used the service. Queens Court provides care across three floors; two floors accommodate people for nursing care and one floor provides residential care.

The service must have a registered manager.

At the time of the inspection, there was no 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.

Our last inspection was conducted on 12 July, 13 July and 14 July 2016. The key question ‘Is the service safe?’ was rated as ‘requires improvement’ and the overall rating for the service was ‘requires improvement’.

The purpose of this inspection was to examine the safety of people’s medicines management. This inspection looked at only one key question; “Is the service safe?” The rating remains as 'requires improvement’ for this key question. The overall rating has not changed.

The management of medicines at Queens Court was not safe. Medicines were not ordered in time from the GP and the community pharmacy. Records regarding medicines were incomplete, missing or damaged so that accuracy of administration could not be established.

Medicines were stored in appropriate areas, but the storage rooms were frequently beyond the recommended maximum temperature. The service and management had not taken action to ensure medicines rooms were at an appropriate temperature.

Medicines errors were reported by staff. However, an accurate record was not always maintained and investigations were not robust. Learning from medicines incidents to prevent recurrence was not demonstrated.

Relatives told us they did not have enough information provided to them about people’s medicines. They told us they witnessed medicines being given but did not know what the medicines were for.

The disposal of medicines was not always appropriate. We found evidence that medicines were sometimes disposed of incorrectly. Records of medicines disposals and destruction were not robust and checks by management for controlled drugs were lacking.

Staff did receive training about medicines safety and administration. Staff also completed competency assessments to check they could safely deal with people’s medicines.

We found one breach 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 back of the full version of the report.

At the time of the inspection, there was no 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. A new home manager commenced in post on 18 January 2016, but at the point of the inspection was not registered. The home manager was due for a ‘fit person interview’ on 19 July 2016 where our registration team would assess the application to be a registered manager.

On 2 November 2015 and 5 November 2015 we conducted a comprehensive inspection of Queens Court and found seven breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009. The service was rated ‘inadequate’ and placed into ‘special measures’. We took criminal and civil enforcement to ensure people’s safety and ensure improvement occurred at the service. We served two fixed penalty notices and two warning notices to the provider following the inspection. A warning notice gives a date the service must be compliant by and we inspect again to check that compliance against the content is achieved within the timescale. The provider was required to be compliant with the warning notices by 31 January 2016.

The provider paid the two fixed penalty notices which we served. This disposed of the offence of two breached regulations. On 19 February 2016, a focused responsive follow up inspection took place to assess compliance with the two warning notices we served. We found the service was compliant with the content of the warning notices. The rating for key question ‘safe’ was changed from inadequate to requires improvement.

When a service is is rated as inadequate and placed in ‘special measures’, we will inspect again within six months. This comprehensive inspection took place on 12 July 2016, 13 July 2016 and 14 July 2016. The purpose was to check what improvements were made and whether the ‘special measures’ framework continues or can be removed.

People felt they were safe at the service. We saw they were protected against abuse and neglect, and that where this was suspected it was reported and investigated. Building and environment risks were assessed, but coordination of the risk management was not achieved. This left some risks unattended to or inappropriately disregarded. We found this was a continued breach of the regulation.

Staff recruitment, retention and deployment had significantly improved. The service had established a nursing workforce, and although agency registered nurses were still contracted, the use was declining through further effort to fill job vacancies. We made a recommendation regarding staff recruitment and the use of agency staff.

Medicines safety had improved through the support of community pharmacists. We made a recommendation that the service continues to work with pharmacists to drive safety.

Staff training and supervision had improved. Staff were attending mandatory training and were meeting with their line managers to discuss their performance.

The service was not compliant with the Mental Capacity Act 2005. The service had applied for additional deprivation of liberty authorisations from the local authority and awaited the outcomes. Further effort was required to ensure that staff correctly completed request forms and met the conditions of the standard deprivation of liberty authorisations.

People received enough to eat and drink. However the calculation of risk for people’s malnutrition was not always adequate. We made a recommendation for staff training on this subject.

People told us staff were kind and caring. People also expressed that they had the ability to be involved in the service and that their privacy and dignity was respected.

We found people’s care plans were personalised and that they were involved in care planning. In some circumstances, people’s relatives took the lead in their care planning when the person was unable to do so themselves.

A positive workplace culture was established at Queens Court. Staff expressed support from the management team and that they enjoyed working at the service. A robust system of checking the quality of care was implemented. A service development plan was in place to drive continuous improvement at the care home.

After our February 2016 inspection, out of the five key questions the service had two requires improvement and three inadequate ratings. After this inspection, the service had received two requires improvement and three good ratings across the key questions. Therefore, with this report, we have determined that the service is no longer in ‘special measures’. We will inspect again within 12 months to determine if further progress and improvement in the care of people who use Queens Court occurs.

There are two continued breaches of regulations since November 2015. You can see what action we told the provider to take at the back of the full version of the report.

At the time of the inspection, there was no 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. A new home manager commenced in post on 18 January 2016, but at the point of the inspection had not registered.

The last inspection was conducted on 2 November 2015 and 5 November 2015. At that inspection, we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took both civil and criminal enforcement against the provider. We issued the provider two warning notices; one for safe care and treatment and one for staffing. We also issued the provider with two fixed penalty notices. This was a focused inspection to follow up the two warning notices from the prior inspection. This inspection looked at only one key question; “Is the service safe?”

After the last inspection, the provider established a series of steps to immediately ensure people’s welfare and safety. These included liaising with the local authority not to admit further people to Queen’s Court, submitting regular action plans to the local authority and providing senior staff input in the operation of the service. Further steps included temporarily increasing staffing numbers to ensure sufficient staff deployment and increasing training for staff to gain the knowledge, skills and competencies they needed to ensure safe care for people.

We found improvements had been made at Queens Court following the last inspection and further changes were planned. Not all aspects of the changes had succeeded but further time was required to implement them and ensure sustainability.

Risk assessments and care plans were fully moved from computer based entries to paper based records. This meant the review and rewriting of everyone’s care documentation. Steps had been taken to ensure better review of people’s planned care. During our inspection however, we found planned care was not always the care that people received.

We found changes in the safe management and handling of medicines. Documentation and control processes around medicines administration had been strengthened by the management. Support workers and registered nurses received training and competency assessments to ensure they safely delivered medicines to people.

Safe staffing deployment was reviewed. Some new care staff were recruited and had commenced in post, including a new home manager, but the vacancy rate of permanent registered nurses was still unsatisfactory. The provider demonstrated they used strategies to attract more registered nurses to work at Queens Court but despite three months since the last inspection, just one new registered nurse had started working at the service. Further effort is required to fill the vacant posts. In the meantime, the provider continued to deploy agency registered nurses.

Staff had the ability to attend and participate in comprehensive training topics since the last inspection. A larger proportion of staff had received training in important topics like safeguarding, moving and handling and infection control. Some staff were booked to attend training in the months following this inspection. Staff had commenced supervision sessions with management, but more staff needed to participate and regularity in supervision meetings was required.

Further improvement in the prevention and control of infections is required at the service. Most areas of the building were clean and tidy on observation, but attention was not paid to handwashing, effective cleaning practices throughout the entire premises and the management of chemicals. However, we found better documentation of cleaning completed and training of cleaners had occurred.

At the time of the inspection, there was no registered manager. The last registered manager left their position in October 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. There had been no registered manager at Queens Court since the last inspection. A series of managers had been in charge of the service since then. The provider told us they were recruiting a new manager who would become the registered manager.

The last inspection was conducted on 13 October and 16 October 2014 under the 2010 Regulations. At the last inspection, we asked the provider to take action to make improvements to people’s care plans and risk assessments, staff personnel files and staff training and support. The provider sent us an action plan on 1 April 2015 setting out how they would take action to address the breaches in regulations. The current inspection occurred over two days on 2 November and 5 November 2015. We found that compliance had not been achieved by the provider with regards to the previously breached regulations. Further breaches are evident under the 2014 Regulations.

People’s feedback regarding Queens Court was mixed, but overwhelmingly critical. They told us that they felt there were too many agency staff working at the care home and this impacted on the quality of the care they received. They also told us that their social and emotional needs were not taken into consideration and there were too few activities, including outings. Several people told us they had provided feedback to staff and management, but often they felt this had not been listened to and no changes were evident as a result. Despite this, people told us about their favourite staff members and that staff were mainly kind and gentle. When we spoke with relatives and visitors they confirmed what people who live at the home told us.

A number of professionals who visited the care home or were involved because of people’s care arrangements expressed their concerns regarding the standard and quality of care at Queens Court. They also told us they were concerned about the lack of leadership, the high use of agency staff and the absence of social activities that people could take part in. Other agencies had increased their monitoring of the service and required the service to keep in regular contact so that people’s safety was not further compromised.

People were safeguarded from abuse and neglect at Queens Court. Staff demonstrated good knowledge of what to do if they suspected someone had been inappropriately treated. The provider was reporting instances where this had occurred to the local authority.

Staff handling medicines had not received satisfactory training or competency assessment to support them with this role. Appropriate protocols were not in place for the administration of ‘as required’ medicines. The location had ordered and overstocked too many medications, leading to wastage.

There was an insufficient investment in staff training. Some staff had not received important training in topics like fire safety, mental capacity and moving and handling. This meant people were at risk of receiving care from staff that did not know how to provide safe and effective assistance. Staff had also not participated in regular reviews of their performance with supervisors. Areas for staff improvement had not been discussed with individual team members.

People’s privacy was maintained and they were treated with respect. There were some examples of staff ‘going the extra mile’ when it came to people’s care. On the whole however, people did not feel part of the service. They told us they had little or no input into the management of the care home. They felt that when they did get to have a say, their opinion was not taken into account by the provider.

People’s care plans and risk assessments required improvement to provide the best care for them. We found examples where the construction of the care documentation was not followed through to ensure gaps had not developed in the planning. Some people and relatives told us they had been involved in the creation of their care plans, and other people said they did not know about them.

We found people’s care was task-focussed and not person centred. We observed people taken to communal lounge rooms in wheelchairs where they sat in front of loud television sets, or fell asleep without staff present. At meal times, people were taken to the dining room and had sufficient to eat and drink, but it was not a sociable environment.

People and relatives were concerned about the leadership and management of Queens Court. They told us they could not determine who was running the care home because there had been many changes in the management. There was not a strong system in place for monitoring, auditing and driving improvements in the quality of care. The provider failed to tell us about important statutory events associated with the care and management of the home.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to this provider and will report on this when it is completed.

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.

Throughout our inspection we observed that staff were respectful, patient and kind to people in their care. There was a quiet, unhurried atmosphere in the home.

Staff were well trained and knowledgeable about people in their care. They felt well supported by management and felt they could have a say in how the home was run. The service had an effective quality assurance in place that sought the views of people who use the service.

Care plans were specific to the individual person and detailed their personal and social care needs. We saw people had been involved in planning their care.

The staff rota had recently been changed at the home. Staff we spoke with said the new rota was an improvement as there were more staff on duty over the busy lunchtime period and there was an additional member of staff working in the afternoons. Some people who live at the home told us they felt staff were available when they needed them.

People we spoke with were aware of how to complain and who to complain to. None of the people we spoke with had any complaints at the time of our visit.