Queens Park Care Home

respect, equality, dignity, choices and independence and good access to local communities that most

people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make

assessments and judgements about services supporting people with a learning disability and autistic people

and providers must have regard to it.

About the service

Queens Park Care Home is a residential care home providing accommodation for people who require personal or nursing care for to up to 16 people. The service provides support to people with a learning disability, autistic people and people with physical health needs. At the time of our inspection there were 10 people using the service.

People’s experience of using this service and what we found

Right Support:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff were recruited safely and there were enough staff to support the needs of people living at the service. Staff had received training to ensure they were skilled and knowledgeable to effectively meet people's needs. People were supported to maintain their independence. People were supported to personalise their rooms and there were communal areas that people could use. People and staff told us the manager was approachable and listened when they had concerns.

Right Care:

There was a relaxed atmosphere in the home. Where people required support with personal care this was provided with dignity and privacy. People were given choices about the way in which they were cared for. Staff listened to them and knew their needs well. People received their medicines safely. The service worked in partnership with other healthcare professionals to maintain positive outcomes.

Right Culture:

Staff encouraged people to be as independent as possible and respected people's privacy and dignity. We saw staff had formed good relationships with people they supported. People were provided with the opportunity to make suggestions and feedback on their experience, which was taken into account to improve the service. People were protected from the risk of abuse. Risks were assessed and managed effectively. The management team were new to the service and had made improvements since the last inspection. Audit systems had improved but still needed to be embedded and sustained.

Overall the service is meeting 'right support, right care, right culture'. We are aware this is a large service supporting up to 16 people and therefore is larger than good practice guidance suggests.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 6 October 2022) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 15 July 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Queens Park is a residential care home providing the regulated activity of Accommodation for persons who require nursing or personal care, for up to 16 people. The service provides support to people with mental health, learning disability, autism and physical health needs. At the time of our inspection there were 14 people using the service.

People’s experience of using this service and what we found

Staff were not provided with enough clear guidance to support people safely. Lessons were not learnt when things went wrong. There were enough staff to support people safely. People were not always safe from neglectful care. Medicines were managed safely. Safe infection control processes were followed to reduce to spread of infections through the service.

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 and in their best interests. The systems in the service did not support more effective practice. Staff had always not been provided with training to complete their roles effectively. We were not assured that safe end of life care would be provided for these reasons.

Staff were mostly kind to people and promoted their independence, however the poor safety culture of the service meant it was not always caring.

We saw that two healthcare referrals were not made in a timely way. However, other referrals had been made. Two visiting health professionals fed-back positively about their involvement with the service. Staff communicated with people using suitable language. Staff knew people’s varied preferences.

Staff did not always keep records of what care was provided. There was a lack of oversight of these records. Due to the poor record keeping, we could not be assured that people were receiving the care they required .

There was a lack of effective oversight at the service. This meant the provider would not be able to recognise when things had gone wrong or be able to quickly make improvements. The provider has given assurances that improvements will be made.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 8 October 2021).

Why we inspected

We had received concerns that people using the service did not receive enough food to eat. We also received concerns that there were not enough staff. We therefore decided to inspect and examine these areas.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care, consent, staff training and governance. We have sent the provider a warning notice for the breach of regulation 12 (safe care). This warning notice gives them a specified time to make improvements. We will follow up to assess if improvements have been made.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Queens Park Care Home provides care and support for up to sixteen people with a learning disability and autistic people. Some of whom have additional needs relating to mental health and/or physical disability in an adapted building. At the time of our inspection there were fifteen people using the service.

People’s experience of using this service and what we found

We have made a recommendation about updating practice with regards to working with people with a learning disability and autistic people.

Staff treated people with kindness, dignity and respect. We observed positive interactions between people and staff, and feedback from people about staff relationships were good. One relative told us, “Even during [COVID-19] lockdown, it was so nice [they] were with the staff and [their] friends at Queens Park Care Home. I am delighted at how the care staff talk to [them] and the respect that they show [them].”

People told us they liked living at the service and they were happy. They told us staff were nice to them and supported them to make choices, to access health services and take part in activities.

People were safe as they were supported by staff who understood about the risks of COVID-19 and had abuse awareness. Staff understood how to report concerns to keep people safe and where to go for additional advice.

There were enough staff. People and their families told us they received the care they required. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.

The service was clean, tidy, and staff followed infection control procedures.

People were supported safely to manage their medicines and health conditions. Storage and administration of medicines was safe, and staff had received training in this area.

Relatives told us staff communicated with them, however some relatives reported they had wanted more communication from staff during the COVID-19 pandemic than what they received. People and relatives were both happy and confident to speak with the registered manager or staff team if they had any concerns.

Audits and checks were in place to find and act on any areas for improvement. Staff felt well supported by the management team.

The management notified Care Quality Commission (CQC) of specific events, as and when required.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of safe and well-led; the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

People told us staff treated them well and they were able to do what they wanted to do. Relatives also told us that staff always treated their family member with respect and kindness.

The needs and quality of life of people formed the basis of the culture at the service. Staff understood their role in making sure that people were always put first. We observed people receiving care that was genuinely person centred. However, improvements were needed regarding the use of appropriate language on care planning documents, to ensure good practice was followed and understood by staff.

The leadership of the service had worked hard to create a learning culture. Staff felt valued and empowered to suggest improvements and question poor practice. There was a transparent and open and honest culture between people, those important to them, staff and leaders. Staff felt confident to raise concerns and complaints and were passionate to improve outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 11 January 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We received concerns in relation to staffing levels. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Queens Park Care Home on our website at www.cqc.org.uk.

Queens Park Care Home provides care and support for up to 16 adults with a learning disability, some of whom have additional needs relating to mental health and/or physical disability. At the time of our inspection there were 15 people using the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people living with autism and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance the Care Quality Commission (CQC) follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People did not always receive person-centred care and treatment that was appropriate to meet their needs and reflected their personal preferences. The systems in place to learn from incidents was not always used effectively to drive improvements.

Care plans and risk assessments contained contradictive information and had not always been updated to reflect people’s changing needs, which meant staff did not have access to up to information about people.

Risk assessments and care plans did not contain enough guidance for staff to know how to respond to people's behaviour appropriately to keep themselves and people safe.

The provider did not use a systematic approach to determine staffing numbers to ensure they were safe and appropriate to meet people’s needs. There was a high use of agency staff during the day and night shifts. The manager told us they were recruiting for more permanent staff to reduce the number of agency staff used.

Some areas of infection control and prevention practices did not follow best practice. Some staff were not wearing appropriate masks and we observed some staff wearing their masks below their nose. We saw some open waste bins, one containing discarded Personal Protective Equipment. (PPE).

There was no effective process in place to ensure that accidents and incidents, safeguarding incidents and complaints were analysed to look at trends and themes. The manager was addressing this to ensure lessons were learned when things went wrong.

Quality monitoring checks were not always effective at identifying areas that required improvements. For example, they had not identified the issues with out of date risk assessments and care plans. Records management was disorganised, and different records were stored in various areas. The manager had identified this as an area that needed to be addressed.

People told us they felt safe living at the service. Staff told us they had completed safeguarding training and understood what whistle blowing was. They said they would report any matters of concern. Robust recruitment checks had been completed to ensure only suitable people were employed to work at the service.

The environment was visibly clean and hygienic. Housekeeping staff completed cleaning routines throughout the day of our inspection. All people using the service had in place a COVID-19 care plan, risk assessment and testing consent form. Staff were trained in infection control, hand hygiene and COVID 19.

Systems were in place to ensure the proper and safe management of medicines. People received their medicines as prescribed.

There was a manger in post who was in the process of registering with the Care Quality Commission. They were supported by a deputy manager who was four weeks into her role. We found they worked well together and shared the same vision for the service.

The manager had introduced some improvements at the service which staff were positive about. We found good working relationships with other health care professionals when people needed support with their care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 12 March 2019)

Why we inspected:

We received concerns in relation to the safe use of restrictive interventions and safeguarding people from abuse. In addition, we received concerns about a lack of staffing, infection control practices and a lack of training for staff to support people to manage their behaviours. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Queens Park Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified one breach of regulation in relation to good governance.

Please see the action we have 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 is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Queens Park worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service:

People were safe at the home. A relative said, “[Family member’s] always happy every time we talk and never says anything that worries us.” People were supported to reduce risk to themselves. For example, people had emergency call bells in their room to summon assistance. A person said, “The staff do hourly checks at night to see if you’re breathing, or if you’ve left your telly, or are asleep wearing your glasses.” The home was well-staffed and all areas were clean and tidy. People had their medicines safely and, where possible, took some responsibility for them.

The staff were well-trained and knowledgeable and had a good understanding of the people they supported. A person said, “The staff know what I like and what I don’t like.” People were supported to prepare their own meals where possible. A person told us they made their own breakfast and were learning how to make poached eggs with their keyworker. People’s medical needs were met by a range of healthcare professionals who visited the home. People’s rooms were personalised and they chose what was in them and people had access to a safe garden area and a sensory room.

The staff were caring and kind. A relative said, “The staff are wonderful. I’ve faith in the staff - they’ve become dear friends.” Staff had a good rapport with people and knew how best to communicate with them. For example, they understood people’s non-verbal ways of expressing themselves. People made decisions about their own routines and were encouraged to make independent choices about all aspects of their lives.

Staff provided people with personalised care and supported them in the way they wanted. For example, a relative told us staff knew what to do if their family member had a low mood. They said, “They see them through it absolutely. If [family member] is tearful they take them to one side. They are brilliant.” People were encouraged to have goals which staff supported them to achieve, for example going for walks independently, making meals, or going on a day trip. People took part in a range of mainly one-to-one activities and staff supported them to follow their own hobbies and interests.

The service was well-managed and people and relatives were satisfied with the care provided. A relative told us, “[Family member] absolutely loves it here. I couldn’t rate it highly enough. The staff always go the extra mile.” People, relatives and staff said the managers were friendly, approachable, and supportive. A person told us the names of all the managers at the home and said, “I like them because they do a good job.” The provider and registered manager carried out audits to ensure the home was operating effectively and safely and acted if improvements were needed. People, relatives and staff were asked for their views on the home and consulted on how it was run.

For further information please see the full report.

Rating at last inspection: At our last inspection (report published on 09 April 2016) the service was rated as Good.

Why we inspected: This was a scheduled inspection based on the service’s previous rating.

Follow up: We will continue to monitor this service.

Queens Park Care Home is registered to provide residential care and support for sixteen people with a learning disability, mental health needs, physical disability and degenerative health conditions which include Huntington’s Disease and Muscular Dystrophy.

The service is purpose built and provides accommodation over two floors. The ground floor comprises of a dining room, activities room, lounge and sensory room. Bedrooms, which have en-suite facilities, are located on the ground and first floor and are accessible via a stairwell or passenger lift. Bathing facilities also provide sensory stimulation to people using the service along with equipment to support those with a physical disability.

Queens Park Care Home had a registered manager in post. 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.

Health and social care professionals we contacted as part of the inspection were positive about the service provided, they felt staff had the appropriate skills and knowledge to meet people’s needs in an individualised and personalised way. They found staff to be committed to providing a good service, and that there was good communication across all staff and that the service was managed well.

Staff told us that training had helped them to understand the needs of people, which included people’s right to make decisions about their day to day lives. Staff were confident that if they had any concerns about people’s safety, health or welfare then they would know what action to take, which would include reporting their concerns to the registered manager or member of the management team along and to external agencies.

People were supported by knowledgeable staff that had a good understanding as to people’s needs. Staff provided tailored and individual support to keep people safe and to meet a range of complex needs related to people’s health, which required staff to use specialist equipment and monitor it for its effectiveness. Staff provided tailored support where people’s behaviour became challenging, to ensure that people could be confident that they would be supported and safe when accessing the wider community.

We found people received their medicine in a timely and safe manner by staff that had been trained in the administration of medicine, which included where people’s medicine was administered by the use of equipment.

Our discussions with staff told us that they received ongoing support and development through supervision, appraisal and the accessing of training. The training staff accessed reflected the needs of people who used the service which meant people received effective care and support. Records confirmed staff had received training in a wide range of topics. This meant people at Queen’s Park Care Home were supported and cared for by knowledgeable staff, which ensured their safety and promoted their health and welfare.

People were protected under the Mental Capacity Act Deprivation of Liberty Safeguards (MCA DoLS) we found that appropriate referrals had been made to supervisory bodies where people were thought to not have capacity to make decisions. Staff we spoke with were knowledgeable about their role in supporting people to maintain control and make decisions which affected their day to day lives and told us how this was a key part of their role.

People were supported to have sufficient to eat and drink and had their dietary needs met, which included where specialist equipment was required. People were supported to access a range of health care appointments by staff to ensure their health was monitored and maintained. Staff were proactive in responding to people’s health care needs and liaising with health care professionals effectively.

People were supported by staff that had developed positive and professional working relationships with them; this gave people who used the service the confidence to communicate with staff about issues affecting them. People were relaxed in the company of staff and were able to communicate their lifestyle choices and talk about the impact their decisions had on their well-being and future plans.

Staff had the appropriate knowledge and skills to communicate with people, and used a range of communication methods to promote people’s communication and to assist them in making decisions. Staff carried on their person ‘flash’ cards, which were photographs reflecting a range of items, which included food and drink, and to capture people’s moods such as happy or sad. This enabled staff to communicate as people could point to the cards to indicate their views. A range of documents had been produced in an ‘easy read format’, which used pictures and symbols to assist in people’s understanding of the information.

The registered manager and staff were committed to meeting the needs of people and improving their sense of well-being by encouraging people’s independence and to maintain a good quality of life where people had degenerative conditions, which impacted on their physical health. Staff recorded all their interactions with people, which included personal care and social support on hand held electronic devices. This helped people to receive consistent and timely care as all staff had access to up to date information.

Staff were complimentary about the support they received from the management team and regular meetings, supervision and appraisal provided an opportunity for staff to develop and influence the service they provided.

The provider actively sought feedback from people who used the service, their relatives and health, health and social care professionals and staff working at the service. The information gathered was used to develop the service and to respond to people’s comments to bring about improvement.

The provider had a robust quality assurance system which assessed the quality of the service. Information gathered as part of the quality audits was used to develop the service, which included electronic records detailing the care and support people received, which was audited for its effectiveness.

People we spoke with told us that they visited friends and relatives whilst others told us that relatives’ visited them at the service. People told us about their visits to local shops and supermarkets, swimming activities and day trips. During our inspection we saw people take part in activities within the service, which included people listening to music, painting, completing jigsaws and spending time in the garden.

We spoke with a visiting community support worker who had assessed and placed people at Queen’s Park Care Home. We asked them for their views about the service provided to people. They told us that in their opinion the service goes out of its way to support people and that the services approach is one where they do not say that they can’t manage people’s needs but focuses on ways that they can support and help people. They went onto say that the registered manager and other staff are approachable and amenable and are knowledgeable about the people they support and care for.

People are involved in decisions about their daily lives, which includes what time they get up and go to bed, the activities they take part in as well as decisions about their future. People who are not able to make decisions for themselves are supported by the use of the service following legislation which protects peoples’ rights and by liaising with people’s relatives and other health and social care professionals.

People are provided with nutritious meals which are made using fresh ingredients. People who require specialist diets and feeding systems receive the care and support they require by staff who are aware of people’s individual needs and who receive the necessary training to support people well.

People live in an environment which is well maintained and have a bedroom which is decorated and styled to meet their needs and choices. Two people told us they had chosen the décor and style of their bedroom. People who require the use of a wheelchair are able to access all areas of the service which includes access to the activities room, sensory room and garden.

People’s records as well as records for the smooth and efficient running of the service are well maintained.

People’s needs and the support they required were comprehensively recorded within their support plans. Records showed people accessed a range of health care professionals who work with the staff of the home to monitor and promote people’s health. Monitoring of people’s health included having their medication regularly reviewed and by staff ensuring people received their medication in a timely manner. Records showed staff had received training which enabled them to meet the needs of people using the service.

Information about how to make a complaint, fire evacuation procedures, minutes of meetings and personal information about themselves was available to people living at the home in easy read formats using large print, photographs and symbols to assist people in their understanding.