Quinton House

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• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

There were no clear and effective governance systems in place. Systems in place were not always effective in monitoring or improving the quality of care. The provider did not give the registered manager sufficient support to drive service improvement. The registered manager was not always aware of their legal responsibility to report certain incidents to CQC. Lack of incident and accidents reported meant there were missed opportunities to improve the quality of the service. Information was not always used effectively to monitor and improve the quality of care. The registered manager had begun work to implement best practice guidance to improve people’s quality of life. Staff told us they felt well support and confident the registered manager would act upon any concerns they raised.

This service scored 68 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Shared direction and culture during this assessment. The score for this quality statement is based on the previous rating for Well-led.

The registered manager was supported by a deputy manager and both were experienced, however insufficient support from the provider meant we were not assured the management team were capable and competent in their roles. We found a lack of processes in place to ensure the quality of the service was monitored and maintained. The registered manager did not always promote person centred care which impacted people’s ability to live a fulfilled life. The registered manager displayed an attitude to improve the service but was not always provided with the tools to do this. For example, we found improvements which were required to the building had been reported by the registered manager, but the provider did not take any action. The registered manager did not always understand their role in ensuring people lived free from unwarranted restrictions, as detailed in the safeguarding section of this report. This meant people were at risk of receiving restrictive care. The registered manager was open and honest and visible at the service. They recognised improvements were needed and had started on making some changes to improve the service. For example, they had made significant improvements to infection control processes. However, further work was needed to ensure people were protected from the risk of harm.

The registered manager knew people and their families well. The registered manager told us provider oversight had improved recently. They told us, “The provider answers the phone and will do things now, it’s a lot better than it was.” However, we found little evidence to support this statement, staff referred to the provider as the ‘owners’ but could not tell us their names. Staff told us the provider visited the home infrequently. The provider had little oversight to ensure the registered manager was capable and competent to carry out their role. Staff told us, the registered manager was approachable and present in the home. Staff told us, “The manager is very approachable and friendly, I absolutely trust them.”

We did not look at Freedom to speak up during this assessment. The score for this quality statement is based on the previous rating for Well-led.

We did not look at Workforce equality, diversity and inclusion during this assessment. The score for this quality statement is based on the previous rating for Well-led.

Governance systems in place were not effective. Whilst audits were in place there was no process in place to determine what staff were required to check when completing audits. Audits in place were a tick list of overall areas which were checked but there was no detail to determine what improvements were required. This meant there were limited processes in place to drive service improvement. There was no system in place to audit care records which meant there were missed opportunities to improve the service. For example, daily notes demonstrated the service was not always person centred. This had not been identified prior to our inspection. Policies in place lacked specific detail relating to Quinton House, some policies were generic and provided limited guidance for staff. For example, the emergency planning policy did not provide specific instructions of who to contact in case of emergency. Information was shared at staff meetings. However, information relating to improvements were not always discussed fully. For example, minutes we reviewed detailed the need for good documentation. However, there was no detail in how this would be managed or monitored to ensure improvements were made.

The registered manager did not always understand their regulatory responsibilities they were not aware of some of some of the incidents they were legally required to inform CQC of. For example, a safeguarding concern had been reported to us by the local authority but we did not receive a notification informing us of this allegation. Staff were clear about their roles and knew who to report concerns to internally. Staff felt well supported by the registered manager and told us they would act on any concerns to protect people using the service. The registered manager was aware of their responsibility to apologise when things went wrong. Relatives we spoke with told us the registered manager was open and honest and communicated well.

People told us they were supported to maintain contact with those that were important to them. A person also told us, they were supported to go to a day centre within their local community. A relative we spoke with told us their relative was supported with their health needs and gave us an example of where staff supported them with a hospital visit. They told us of a change to their care which the hospital had instructed was then implemented by staff.

Staff gave us examples where they had worked alongside professional to ensure people’s needs were met. Staff told us they worked alongside the continence service, District nurses, integrated care homes team and GP’s to ensure people’s needs were met. They were able to discuss how they would refer. Staff supported people to access appointments using technology such as MS Teams when in person appointments were not available.

The service did not always act on feedback in a timely manner. A professional we spoke with told us, improvements required to improve the quality of care had been slow and not always received well. For example, infection prevention and control concerns were not always acted upon in a timely manner.

Systems and process in place meant whilst referrals were made the lack of monitoring meant referrals were not always followed up in a timely manner. Any changes following health care appointments were not always implemented in to care plans. This meant staff did not always have correct guidance to follow to ensure guidance was implemented. A communication book was in place to ensure if people had a health appointment on a particular day it was not missed.

Lack of processes in place meant there were missed opportunities to improve and share lessons learnt. Audits were not shared amongst the team and there was little implementation of best practice guidance. For example, the service did not always work in line with Right Care, Right Care, Right Culture. Whilst people and their relatives told us they were happy, they were not always provided with the opportunities most people take for granted. For example, there was a limited choice of activities on offer and people often did not leave the service for days at a time. Records reviewed demonstrated people’s days were often the same despite people having very different hobbies and interests. Staff did however support people to improve their lives skills, for example people were supported to tidy their own rooms and were supported to complete their own laundry. This meant some best practice guidance was implemented.

Staff told us they had acted upon feedback from the local authority to improve the service. Staff told us, “Lots of improvements had been made” following the visits from the local authority. The registered manager told us they had been working with other professionals to develop training at the home to implement best practice guidance. For example, they had worked with the care home teams to implement RESTORE2 training at the home. This training supports staff to intervene early when a person is becoming unwell.