About the service:

Qu’Appelle Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The home is registered to provide accommodation for up to 36 people, including people living with dementia. There were 31 people living in the home on the first day of our inspection. The registered provider also offers day care support in the same building as the care home although this type of service is not regulated by CQC.

People’s experience of using the service:

• People were not receiving safe, effective, caring, responsive or well-led care.

• We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because of shortfalls in organisational governance; a failure to appoint a person with the necessary skills and experience to manage the home; a failure to properly assess and mitigate risks to people's safety; a failure to ensure sufficient staffing to meet people’s needs and keep them safe; a failure to ensure people’s nutritional and hydration needs were properly met and monitored; a failure to ensure staff had the skills and knowledge to support people safely and effectively; a failure to obtain proper consent to care and treatment; a failure to consistently treat people with care and compassion and promote their privacy, dignity and respect; a failure to support people in a consistently person-centred way and to meet their needs for mental and physical stimulation and a failure to properly display the rating of our previous inspection of the home. We also found one breach of the Care Quality Commission (Registration) Regulations 2009 due to a failure to notify us of significant issues involving the people living in the home.

• In other areas, the registered provider was also failing to provide people with the service they were entitled to expect. The provider's approach to safeguarding was ineffective; there was no evidence of effective organisational learning; internal communication required improvement; complaints were not managed in a systematic way; staff morale was low and people's feedback on the running of the home was not listened to.

• In a small number of areas, the registered provider was meeting people's needs. End of life care was provided in close consultation with specialist agencies; people were supported to access to a range of local healthcare services; there were some links between the home and the local community and some refurbishment of the home had taken place since our last inspection. To their credit, staff at all levels were admirably candid in providing feedback on their experience of working in the home.

Rating at last inspection:

Good (Published August 2017)

Why we inspected:

This inspection was scheduled in response to concerns shared with CQC by the local authority safeguarding and contract monitoring teams following their recent visits to the home. At this inspection we found service quality had deteriorated sharply. As result, the rating of the home is now Inadequate and the home is therefore in ‘Special Measures’.

Enforcement:

We are currently taking action against the registered provider to ensure that they make the necessary improvements to become compliant with legal requirements. Full information about the CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

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

Qu'Appelle Care Home is registered to provide accommodation and personal care for up to 36 older people, including people living with dementia. The registered provider also operates a day care support service in the same building as the care home although this type of service is not regulated by CQC.

We inspected the home on 18 July 2017. The inspection was unannounced. There were 35 people living in the home on the day of our inspection.

The home had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

At our last inspection in May 2015 we rated the home as Requires Improvement. On this inspection we were pleased to find that provider had addressed the areas for improvement we had identified and the rating is now Good.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had been granted DoLS authorisations for four people living in the home and was waiting for a further five applications to be assessed by the local authority. Staff had a clear understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people. Decisions that staff had made as being in people’s best interests were correctly documented.

The registered manager maintained a high profile within the home and had worked hard to address the areas for improvement identified at our last inspection. The registered manager had a positive and forward-looking approach and was committed to the continuous improvement of the home in the future. A range of auditing and monitoring systems was in place to monitor the quality and safety of service provision.

There was a warm, relaxed atmosphere and staff supported people in a kind and friendly way. Staff knew and respected people as individuals and provided responsive, person-centred care. People were provided with food and drink of good quality, that met their individual needs and preferences. A range of activities and events was organised to provide people with stimulation and occupation.

There were sufficient staff to meet people’s needs and staff worked together in a well coordinated and mutually supportive way. There was a varied training programme in place to provide staff with the knowledge and skills they required to meet people’s needs effectively. Staff were provided with regular supervision and shift handover meetings were used effectively to ensure staff were aware of any changes in people's needs.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm.

Qu’Appelle Care Home is registered to provide accommodation for up to 36 older people requiring nursing or personal care, including people living with dementia.

We inspected the home on 17 May 2016. The inspection was unannounced. There were 35 people living in the home on the day of our inspection.

The home had a registered manager (the ‘manager’) in post. A manager is a person who has registered with CQC to manage the service. Like registered providers (the ‘provider’) 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of our inspection the provider had submitted DoLS applications for 10 people living in the home which had been assessed and authorised by the local authority.

During our inspection we found a breach of the Care Quality Commission (Registration) Regulations 2009. This was because the provider had failed to notify us of significant incidents relating to the service. You can see what action we told the provider to take on this issue at the back of the full version of this report.

We also found other areas in which where improvement was needed to ensure people were provided with safe, effective care that met their needs. The provider’s approach to risk assessment was inconsistent, increasing the risk to people’s safety and welfare. Audit and quality monitoring systems were also not consistently effective.

In other areas the provider was meeting people’s needs effectively.

Staff knew how to recognise signs of potential abuse and how to report any concerns. Staff also had a good understanding of the MCA and demonstrated their awareness of the need to obtain consent before providing care or support to people.

Staff worked closely with local healthcare services to ensure people had access to specialist support when this was required. People’s medicines were well-managed.

There was a warm and welcoming atmosphere in the home and a range of activities and events was on offer to provide people with stimulation and occupation. People were provided with food and drink of good quality.

Staff knew people as individuals and provided kind, person-centred care. There were sufficient staff to meet people’s care needs and staff worked together in a friendly and supportive way. The provider supported staff to undertake their core training requirements and encouraged staff to study for advanced qualifications.

The manager demonstrated an extremely open and responsive management style, providing a positive role model for other staff.

The provider conducted regular customer satisfaction surveys and the manager encouraged people to come directly to him with any concerns. Formal complaints were managed well.

Summary

Below is a summary of what we found when we inspected Qu’Appelle Residential Care Home on 14 May 2014.

The summary is based on our observations during the inspection, speaking with people who used the service, their relatives and the staff supporting them. We also looked at people’s care records and other documentation.

If you want to see the evidence supporting our summary please read the full report.

During our inspection we focused on our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe.

Safeguarding procedures were in place and staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Recruitment practice was safe and thorough. Required checks had been carried out before staff commenced their employment.

Is the service effective?

People’s health and care needs were assessed. People, and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

We looked at people’s records which showed that care plans set out people’s individual care needs. They were current and the records showed they had been reviewed on a regular basis and adjustments made when a person’s care needs changed.

During our inspection we observed that members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. One person we spoke with told us: “I have been here two years and it’s really wonderful. I know all the staff and they know me.”

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

The provider had a complaints policy in place and information was displayed around the home, should people who lived there or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction to their role. They were able to tell us how they would escalate any concerns raised.

People completed a range of activities in and outside the home on a regular basis. The home had its own minibus, which helped to keep people involved with their local community. There were good links with the local secondary school and pupils were involved in volunteering.

People who used the service, their relatives and friends completed an annual satisfaction survey. We spoke with the manager who told us any comments about how the service could be improved were actioned. However, we did not see any actions plans which supported this and have asked the provider to put these in place to monitor any trends or themes.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

We spoke with five people who lived in the home. Everyone spoke positively about the care they received. One person told us, "They look after me well. It's lovely. The staff are beautiful, wonderful staff." Another person told us, "I am very happy here. I like the staff." They also told us, "There's plenty to do. We do puzzles, bingo, trips into town for coffee, cake baking and exercises."

Some of the people who lived in the home were not able to tell us their experiences. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time and whether they had positive experiences. This included looking at the support that was given to them by the staff.

We spent 30 minutes over the lunch time period watching people having their lunch. We saw staff interacted well with people and at an appropriate pace. People were offered choices about what they would like to eat and the atmosphere in the dining room was relaxed. People told us they enjoyed the new three course menu that had been introduced.

We spoke with two relatives who were visiting the home. One told us, "I give them 100%. Any problems, I can talk to them." Another relative told us, "Both Mum and Dad have been very well looked after. Mum came for a short break but decided to stay."

We spoke with a GP who visiting the home. They told us, "The people receive good care, they are well looked after."

People who use the service told us they were very happy with the care and accommodation they received. They told us they felt safe in the home.

One person told us, “I like it here, I think it’s a lovely place. The staff are gentle they take notice of what I say.” Another person said, “It’s magnificent, brilliant. All the staff are kind and helpful, if you ask for assistance they are there day or night. It’s perfect couldn’t be any better.”

During our visit we spoke with two District Nurses who were visiting. We asked them about their experience of the home. They said, “The staff are always friendly and welcoming. A member of staff remains present when we treat a patient which is very helpful. The staff follow our instructions, we are more than happy and have no issues or concerns.”

We spoke with some relatives who told us they had the upmost confidence and respect for the manager and staff team. “Staff are all knowledgeable caring and friendly. I visit regularly and at different times of the day, I always find it very warm and welcoming. I am always offered refreshments.”

Another relative we spoke with said, “On the whole I give it 100%. Nothing is too much trouble. There is always something going on and families are kept involved.”

The people we spoke with said they had not had to make a complaint but said they would if they had any issues or concerns. They said they had confidence in the manager to respond appropriately if they did. Another person said the communication was very good, they felt they were informed of any changes and consulted, for example they had received a questionnaire asking for their views and wishes about how the service was run.