The inspection took place on the 24 and 25 April 2017 and was unannounced.

Queens Court Nursing Home is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and also treatment of disease, disorder or injury. It can provide accommodation for up to 90 people some of whom maybe living with dementia. On the days of our inspection 49 people were using the service.

At our previous inspection on the 3 and 4 May 2016 the service did not have a registered manager in post although they did have a manager. The manager has now registered with the Care Quality Commission and had been in post since March 2016. At our last inspection the service had shown improvement and was given a Requires Improvement rating to allow for the improvements to be embedded across the service. At this inspection we saw that the registered manager had maintained the stability of the service and had worked hard with the management team to maintain and continue improvements. During our inspection the registered manager and management team were very responsive and dealt with any issues we discussed with them immediately.

The service was not consistently safe. Staff needed to be deployed effectively and the correct staffing levels needed to be maintained throughout the service. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare; however monitoring systems needed to be carried out consistently. People’s needs were met by staff who had been recruited and employed after appropriate checks had been completed. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The registered manager needed to improve their system on checking DoLS authorisations so that renewals were applied for promptly. People were supported with their nutritional needs and had access to healthcare when required.

The service was caring. Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

The service was responsive. People were provided with the opportunity to participate in activities which interested them at the service. These activities were diverse in meeting people’s social needs. People knew how to make a complaint should they need to.

The service was well-led. The registered manager had quality monitoring processes in place to monitor and improve the service. The registered manager had a number of ways of gathering people’s views including talking with people, staff, and relatives.

The inspection took place on the 3 and 4 May 2016 and was unannounced.

Queens Court is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and also treatment of disease, disorder or injury. It can provide accommodation for up to 90 people some of whom maybe living with dementia. On the days of our inspection 49 people were using the service.

The service did not have 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. However the service has had a new manager in post since February and they are going through the process to become registered.

At our previous inspection on the 6, 7, 8, October 2015 the service was placed in special measures due to the overall rating being inadequate. We did a follow up inspection on the 18 and 19 January 2016 to see if the provider had made improvements. We found the service was improving but rating remained unchanged and special measures continued. This inspection was a complete review of the service. From our findings and the improvements made at the service they will no longer be in special measures and their overall rating will now be requires improvement to allow the provider time to imbed and sustain the changes they have made at the service.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, however monitoring of care needed to be improved. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. Medication was dispensed by staff who had received training to do so.

People were safeguarded from the potential of harm and their freedoms protected. Staff were provided with training in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was up-to-date with changes to the law regarding DoLS and knew how to make a referral if required. However, some referrals needed to be pursued to completion.

People had sufficient amounts to eat and drink to ensure that their dietary and nutrition needs were met. The service worked well with other professionals to ensure that people's health needs were met. People's care records showed that, where appropriate, support and guidance was sought from health care professionals, including a doctor and district nurse.

Staff were attentive to people's needs. Staff were able to demonstrate that they knew people well. Staff treated people with dignity and respect.

People were not provided with enough activities to keep them stimulate or address their well-being. People knew how to make a complaint; complaints had been resolved efficiently and quickly.

The service had a number of ways of gathering people’s views including talking with people, staff, and relatives. The manager and provider carried out a number of quality monitoring audits to help ensure the service was running effectively and to make improvements. However, work was still needed to ensure correct recording in care documents.

The inspection took place on the 19 and 20 January 2016 and was unannounced.

Queens Court is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and also treatment of disease, disorder or injury. It can provide accommodation for up to 90 people some of whom maybe living with dementia. On the days of our inspection 63 people were using the service.

The service did not have 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.

At our previous inspection on the 6,7,8, October 2015 the service was placed in special measures due to the overall rating being inadequate. This inspection was to assess what measures the service had taken to improve nursing care.

The overall rating for this service remains ‘Inadequate’ and the service is therefore in ‘Special measures’. Although we found that the service had made improvements across the service and care people received, they needed to sustain improvements over time to ensure people’s on going safety and good quality care.

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.

At this inspection we found that risk assessments were clearer and new care plan documentation was in the process of being implemented to inform staff how to best support people.

People were receiving effective pressure area care. Medication management had improved although there were still areas that needed to be improved upon, for example prompt ordering of medication.

People’s healthcare needs were met in a timely manner, and staff had received additional training to support people’s physical healthcare requirements.

The service had implemented effective quality monitoring processes to have an effective overview of the service; and to monitor its performance or to look for ways of improving the service for people.

Before this inspection the Care Quality Commission (CQC) received some information of concern regarding people’s care and welfare. It was alleged that people living at Queens Court were not safeguarded through the provision of effective care, that people were got up early in the morning by night staff and provided with personal care and that the food provided on occasions was not always of good quality. This inspection was therefore carried out in response to these concerns and to follow up on previous non-compliance.

The inspection was carried out by two inspectors who gathered evidence against the outcomes we inspected to help us answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We found that people’s individual needs had been appropriately assessed before they were admitted to Queens Court Nursing Home. After admission to the home, we saw that needs were regularly reassessed to ensure people received the safe care they required. This meant that staff had appropriate guidance to follow so as to minimise potential risks to people’s safety and welfare.

People told us they felt safe with the staff supporting them. One person said, “All the staff are nice to me, they really care and help me with whatever I need.” Another person told us, “I would rather not be here of course, but the staff know me, I know them, it works.”

We found that staff were aware of the different types of abuse and what action to take if they suspected abuse had taken place. Systems were in place to ensure that lessons were learnt from safeguarding investigations. The home worked in accordance with its safeguarding policy and liaised with the local authority when required. This reduced the risk to people and helped the service to safeguard people.

Is the service effective?

We spoke with nine staff and found that they had received the training and support they needed to do their job effectively. We observed staff engaging with people in a positive manner and when we spoke with staff, we established that they had a good working knowledge of people’s preferences. They were able to advise us about the support people needed, and how they delivered their care. We found that this information was reflected in each person’s care plan which demonstrated that people’s needs were effectively met.

Some of the people at Queens Court Nursing Home had complex needs and often required support to make safe decisions. Where people's ability to choose had been impacted upon by dementia, we found that the records contained appropriate information about their care needs and abilities. This meant that staff were guided to support people to express themselves and make their feelings and wishes known.

We found that people were involved in the planning and development of their care plan, which they had been asked to sign. Where they were not able to do so a representative had been involved if applicable.

Staff spoken with said that they had been provided with appropriate training and the records we saw supported this. We found that supervision and appraisal for staff had been regular and were told that the manager had an ‘open door’ policy so that anything could be discussed. This demonstrated that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

Is the service caring?

The staff presented as very friendly and helpful. We heard staff encourage people to be independent and provide them with timely assistance when required. One person told us, “They are always there if I need help.” This demonstrated that people felt supported and respected by the staff that were caring for them.

Is the service responsive to people’s needs?

We saw that there was sufficient staff on duty to meet people's needs on the day of our inspection. This was also confirmed by the staff and people we spoke with.

The staff we spoke with had a good understanding of how to support people in a way that respected each person as an individual, each with their own needs and wishes.

Is the service well-led?

The staff we spoke with said the manager was approachable, and always there to help them. We were also told that staff were flexible in their approach and willing to offer support. Staff said, “We help each other and are here for the residents.”

We found that staff meetings had been taking place as required and that there was a philosophy of effective communication between all staff, which helped to ensure people’s needs were met and responded to safely.

Some people were satisfied with the care that they or their relatives received at Queens Court. However, one person raised concerns that staff had not consulted their care plan before assisting them. They told us: "Night time is the biggest problem. [There are] new staff [caring for me] at night time. They have no idea. First thing I ask them is, "Have you looked at my care plan?" They say no. I have to say to them it's no good. I say to the senior [carer] but they say, “What can I do? I've got no staff."

Whilst we saw good examples of care planning in respect of relevant risk assessments and care plans being completed, we saw that significant elements of people’s needs were overlooked.

People that we spoke with had mixed views about the meals available. We found that people had a sufficient choice of nutritious food.

We found that medicines were not safely managed for the protection of people using the service.

A relative said, "Some [staff] are helpful. Some not too helpful." Staff did not receive appropriate training, supervision or professional development and appraisal to enable them to deliver care and treatment to an appropriate standard.

There was a complaints procedure available. A visiting relative told us, “I tell them about any issues and they listen.”

We found that records were not kept securely and personal records were not accurate or fit for purpose.

We carried out an inspection following receipt of a communication that stated that there were insufficient staff to meet people’s needs. We spoke with the recently appointed manager who told us that they had placed a voluntary embargo on admitting new people to the home when they took up their post in December 2012. The manager told us that they had their own bank staff but if necessary the home arranged for agency staff to cover shifts in emergency situations to ensure that staffing levels were maintained.

We spoke with six people and two relatives of people who lived at the home. One person told us, "If I call they come quickly." Another person said, "Sometimes I have to wait but not very often."

We spoke with staff members on each of the units. They told us that they were busy but believed that there were sufficient staff members to provide the proper care for the people on the units in which they worked.

The evidence that we gathered during our inspection indicated that there were enough qualified, skilled and experienced staff to meet people’s needs.

We did not speak with people who used the service about records.

One person told us they were "very well looked after" and "there's always something to do".

Another person said that staff "come in and ask you how you are. Nothing is too much trouble".

The inspection took place on the 6,7and 8 October 2015 and was unannounced.

Queens Court is registered to provide accommodation for persons who require nursing or personal care, diagnostic and screening procedures and also treatment of disease, disorder or injury. It can provide accommodation for up to 90 people some of whom maybe living with dementia. On the days of our inspection 78 people were using the service.

The service did not have 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.

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 12months. 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.

During our inspection we became concerned that people were not being looked after safely. Risk assessments and care plans did not adequately show staff how to support people. People were placed at risk, because they were not receiving effective pressure area care, due to unsafe medication management and people’s healthcare needs were not responded to in a timely manner and in the best way to meet their needs. Trained Nursing staff were responsible for people’s healthcare and unable to respond to people’s needs in part due to not having received adequate training and support from the provider. There were insufficient staff available to meet people’s needs. The service did not have effective governance processes in place to monitor and improve the service.

People’s needs were not always met because there were times when staff were not deployed in a way to meet these needs. Staff did not always have the appropriate recruitment checks in place, which allowed them to work with people safely.

Staff were not always supported to fulfil their role. Training had not always been effective.

People’s healthcare needs were not always met in a timely manner, putting people at risk of poor healthcare outcomes.

Care plans were not individual or informative on how people would like to be supported. People were not involved in the reviewing of their care needs. People were not always supported with activities that engaged and interested them to ensure their well-being.

Staff, at times, were not attentive to people’s needs and did not always treat them with dignity and respect.

The service had a complaints procedure; however, this had not always been followed through to conclusion or to people’s satisfaction.

The service was not using effective quality monitoring processes to monitor its performance or to look for ways of improving the service for people.

Staff demonstrated some knowledge in Safeguarding Adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew to make appropriate referrals to DoLS. People were not always supported with choice over their care needs.