Regency Care Home

About the service

Queensferry Court Care Home is a care home providing personal and nursing care to up to 56 people. The service provides support to people with a physical disability, sensory impairment, mental health needs and older people, including those with dementia. At the time of our inspection there were 19 people using the service.

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

Improvements had been made to ensure people were protected from the risk of harm. Since our last inspection, improvements in record keeping demonstrated staff had guidance on how to support people safely. One person’s repositioning chart demonstrated they were not always repositioned as recommended in their risk assessment. Despite this the person’s pressure sore was healing. Overall records seen showed risks to people were managed in accordance with their risk assessment.

Improvements were seen in the infection control practices and cleaning standards at the home. Staff spoken with knew how to raise a safeguarding concern and where to find this information. Improvements to the management of medicines were seen and people received their medicines as prescribed. Improvements to the support and training provided to staff had been developed to ensure staff received training and were competent to support people safely.

The support and guidance provided to staff helped them to understand their roles and responsibilities which improved outcomes for people. Overall, lessons were learnt when things went wrong but we did identify one area regarding the Control of Substances Hazardous to Health (COSHH) were still not always followed. One kitchenette cupboard had 2 spray bottles of cleaning substances in. However, staff were in this area, and we were advised these had been used to surface wipe tables before breakfast and would not be kept in this cupboard after breakfast had finished. We saw these were removed from this communal area and securely stored. All other areas were free of COSHH to ensure people were not put at risk of harm from dangerous substances.

Staff understood when accidents, incidents or near misses should be reported. Improvements in the governance systems meant risks or areas for improvement were overall identified and acted upon.

Staff worked alongside relevant healthcare professionals and improvements had been made to ensure staff were clear on recommendations to follow to help improve people’s health outcomes. One visiting health professional confirmed this. They told us, “I have seen a lot of improvement. The staff are a lot more focused and open. Now they are listening to the recommendations we make. The new temporary manager has worked with the staff really well and improved staff morale.”

Rating at last inspection

At our last inspection we found breaches of the regulations in relation to people’s safe care and treatment, staff training and the management and governance of the home. The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

The overall rating for the service has not changed following this targeted inspection and remains inadequate. We use targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

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

Follow up

The overall rating for this service is inadequate and the service remains in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.

If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.

For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.

Queensferry Court Care Home is a care home providing personal and nursing care to up to 56 people. The service provides support to people with a physical disability, sensory impairment, mental health needs and older people, including those with dementia. At the time of our inspection there were 39 people using the service. Within the home there are 3 wings, split over 2 floors with communal lounges and dining areas. People have access to a secure outdoor area.

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

People were not always protected from the risk of harm. Records were not always accurate or complete which meant staff did not always have guidance to support people safely. The home was not cleaned to a high standard, well maintained or free from environmental risks. Not all staff knew how to raise a safeguarding, or where to find this information. Lessons were not always learned when things went wrong and staff did not always recognise when accidents, incidents or near misses should be reported. Medicines were not managed safely, and people did not always receive their medicines as prescribed.

Lack of oversight and poor governance systems meant some risks, or areas for improvement, were not always identified and acted on quickly. Staff did not receive clear guidance or direction to understand their roles and responsibilities which impacted on people’s outcomes.

Staff were not suitably trained to carry out their roles. People were placed at risk of malnutrition and dehydration. Staff worked alongside relevant healthcare professionals; however improvements were required to ensure staff were clear on recommendations to follow to help improve people’s health outcomes. Not all areas within the home were dementia friendly, or accessible.

People’s holistic needs were assessed prior to moving into the home, which included nationally recognised evidence based tools. 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.

People, relatives and staff had some opportunities to feedback into the running of the service. The provider was working alongside partner agencies to improve safety to people using the service.

Staff were recruited safely, and there was enough staff deployed at the service.

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 30 April 2021).

Why we inspected

We received concerns in relation to the management of pressure care, food and fluid monitoring and oversight at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to inadequate based on the findings of this inspection.

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

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, staffing, nutrition and hydration and governance at this inspection.

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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.

Queensferry Court Care Home Queensferry Court Care Home is registered to provide personal care and accommodation for up to 56 older people and younger adults. The service can support people that are living with dementia, have a physical disability or require support with their mental health. The service provides long term care and supports people who require rehabilitation following a hospital admission. 46 people were using the service at the time of the inspection.

We found the following examples of good practice.

A COVID - 19 screening questionnaire and track and trace details was required for all visitors, to complete upon entry. Temperature checks, hand washing facilities and hand gel were in place to comply with the required guidance.

During the COVID - 19 outbreak the provider had closed the home to non-essential visitors and people were supported to contact their relatives and friends through video calls and telephone calls.

Government guidelines were being followed to enable essential care givers to continue to visit the home.

Enhanced cleaning schedules included regular cleaning of touch areas such as handrails and door handles. This reduced the risk of cross infection.

Staff changed into and out of their uniforms at work. This reduced the risk of infection spread.

Staff had received training in infection prevent and control and the use of personal protective equipment (PPE).

Staff were observed wearing PPE appropriately.

Staff and people living in the service accessed regular testing for COVID-19, so that action could be taken swiftly if anyone developed symptoms or had a positive test result.

The infection prevention and control policy was up to date.

People and staff had risk assessments in place to identify their individual risks associated with COVID-19. We saw protective measures were in place to keep people and staff safe.

Queensferry Court Care Home is a nursing home providing personal care and accommodation for up to 56 people. At the time of our inspection 26 people were using the service.

The service is over two floors and is separated into different zones. The service supported people on short term placements on a ‘discharge to assess’ scheme. This scheme allowed people to live at Queensferry Court, while they and professionals decided long term care arrangements. As part of this scheme, external physio and occupational therapists worked closely with the service.

As well as the ‘Discharge to assess’ scheme, people also remained at the service longer term.

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

We identified a few concerns about the recording and administration of medicines that are taken “as needed”. We found that during the night shift, the environment was not always safely managed. We observed that kitchen staff did not always wear the correct personal protective equipment. We reported these concerns to the registered manager, they told us that after the inspection these concerns were resolved.

We observed staff were well trained and knew people’s care needs well enough to ensure that they were supported safely and effectively. The service was clean.

There were enough staff and staff were safely recruited. If needed, referrals were made to other professionals. Professional advice was documented and followed, for example GPs and physiotherapists.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We observed positive caring interactions between people and staff. Visiting professionals we spoke to reported that the service was caring.

There was a clear governance process to ensure that records were audited at the service. The registered manager oversaw the care staff work to ensure it was effective. Staff spoke highly of the registered manager and felt the service was managed well.

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

Rating at last inspection

This service was registered with us on 13 January 2020 and this is the first inspection.

Why we inspected

The inspection was brought forward. This was partly due to an incident that had occurred at the service, where a person had fallen and sustained serious injuries. At the time of the inspection, this incident was still being investigated by the local authority. We had also received concerns about: Infection control procedures, incident management, people being at risk of pressure related skin damage, poor moving and handling, dehydration and medicines.

A decision was made for us to inspect and examine those risks. We found some areas that needed improvement (reported in the safe part of the report). However, overall the service was ‘Good’.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may choose to inspect sooner.

We found the following examples of good practice.

¿ The home was closed to visitors. Families and health care professionals had been informed and kept up to date about visiting restrictions.

¿ Temperature and track and trace checks were performed upon entry to the home to minimise the risk of transmission. All visitors were offered Personal Protective Equipment (PPE) and a COVID-19 test.

¿ While the home was closed the service used video-calls and phone calls to keep families in touch. When visiting was allowed, the service had a large conservatory which allowed pre-booked visiting through windows, in the garden or with Perspex screens inside.

¿ Staff arrived at the main entrance for testing purposes and were then able to access areas they worked in without walking through the home. Staff changed into uniforms when they arrived at work and removed them before they left to prevent the transmission of infection.

¿ People had been isolated in their rooms to prevent cross infection. Wings of the home were zoned to separate people who had COVID-19 from those who did not. Staff were allocated zoned areas to work in and did not move around the home.

¿ Rooms were not ensuite but had wash hand basins, equipment in rooms was cleaned after use. Cleaning of communal toilets and bathrooms had been enhanced and were cleaned after each use by housekeeping staff to prevent cross infection.

¿ Enhanced cleaning also included frequently touch areas to reduce the risk of cross infection. The registered manager had purchased a sanitising machine for communal areas.

¿ People and staff were able to maintain social distancing in spacious communal areas. People could access entertainment, activities and exercises on a large smart TV in each lounge.

¿ Following audits, furniture in lounge areas was being replaced and upgraded to meet infection control guidelines. In other areas floors had been replaced to ensure easy cleaning.

¿ The provider had a good supply of PPE and there were PPE stations with clinical bins to prevent cross infection when providing care.

¿ The provider performed checks of temperature and oxygen saturation to identify symptoms or deterioration in people’s condition.

¿ Staff including agency staff used, were tested on a very regular basis to identify symptoms of COVID-19 early.

¿ The provider obtained profiles for agency staff and booked them for a continuous period to minimise the risk of cross infection.

¿ Staff had received additional training in infection control and prevention and handovers were used to discuss best practice, concerns and learn lessons.

¿ People and staff had risk assessments in place to identify anyone at high risk that may need to shield.

Queensferry Court Care Home is situated in the suburb of Allenton which is three miles south of Derby and is owned by Agincare (Derby) Limited. Queensferry Court Care Home is registered to provide personal care and accommodation for up to 56 older people and younger adults. The service can support people that are living with dementia, have a physical disability or require support with their mental health. The service provides long term care and supports people who require rehabilitation following a hospital admission. The service had 6 beds available for people discharged from hospital with a positive Covid-19 status.

We found the following examples of good practice.

¿ The service had identified a dedicated unit to support people safely who were admitted to the service with Covid-19. Access to and from this unit was separate from the rest of the home. A cohort of staff would work in this unit to minimise the risk of transmission.

¿ A Covid 19 screening questionnaire was required for all visitors, to complete upon entry, hand washing facilities and hand gel were in place to comply with the required guidance.

¿ People using the service were not receiving visitors at the time of the inspection as an additional precaution to protect people. However, other methods of contact were encouraged, for example, video and telephone calls.

¿ Enhanced cleaning schedules included regular cleaning of touch areas such as handrails and door handles. This reduced the risk of cross infection.

¿ People were supported to remain active through live streamed activities via smart televisions. Games, puzzles and daily newspapers were available to everyone using the service.

¿ To reduce the risk of infection transmission, staff no longer worked across different units and when they arrived at work, they then changed into their uniforms. Staff had received additional training in infection prevent and control and the use of PPE.

¿ If agency staff were needed the service used two regular agencies and regular staff from these agencies, who were risk assessed and received testing weekly.

¿ Staff and people living in the service accessed regular testing for Covid-19. This meant action could be taken swiftly if anyone developed symptoms or had a positive test result.

¿ The infection prevention and control policy was up to date. People and staff had risk assessments in place to identify their individual risks associated with Covid-19. This meant protective measures could be put in place to keep people and staff safe.

We were assured that this service met good infection prevention and control guidelines as a designated care setting.

Further information is in the detailed findings below.