This inspection took place on 3 September 2018 and was unannounced.

Queens Oak Care Centre is an 89 bed purpose built care home set out over four floors. The service is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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. 82 people were residing at the home when we visited.

At our last inspection in August 2017, we made a recommendation in relation to the storage of confidential records. We rated the service ‘good’ overall.

On 17 August 2018, Lambeth Council informed us of their decision to formally suspend all new long and short-term placements at the home with immediate effect. This decision was made in response to concerns raised about the quality and safety of care being provided.

This inspection was brought forward due to concerns about the safety and stability of the service.

The service did not have a registered manager in post. A home manager had recently been appointed and told us she would be registering with the CQC to become the registered manager in due course. A registered manager is a person who has registered with the CQC 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.

CQC was not able to monitor the operation of the service effectively because the provider was not always notifying us of safeguarding concerns, incidents, accidents and events that prevent the service from running normally.

Staff were not always effectively deployed. People told us that staff did not always respond quickly to their requests for assistance. This meant people were left unsupervised for long periods and their care, treatment and support delayed unnecessarily. As a consequence, staff were not always supporting people to maintain their dignity.

Care plans contained some information about what was important to people and about how their needs should be met. However, this often lacked sufficient detail to implement responsive person-centred care.

Risk assessments did not always provide clear guidance to staff as to how to manage identified risks associated with people’s care and support.

Staff were not always following safe practice in regards to the administration and recording of people’s prescribed medicines. People were not always having their medicines reviewed in a timely manner.

Staff training was not well managed and systems were not in place to ensure all staff practiced in a safe and caring way.

Staff understood how to recognise and respond to safeguarding concerns to keep people safe. However not all staff were aware of how to raise a concern outside the organisation.

Staff were responsible for ensuring people had enough to eat and drink. However, we observed drinks being left out of reach and people being left with drinks in their hands with nowhere to place them. Snacks such as biscuits, cakes and fruit were available throughout the day for people to help themselves to. However, this may have meant staff were unable to monitor those with specific nutritional needs.

People told us there were not enough activities. Despite there being an activities coordinator in post, adequate steps had not been taken to ensure regular and meaningful activities were appropriately planned, organised and accessible.

People did not always experience meaningful and caring interactions with staff. This was needed to reduce the risks of social isolation and to enable people to feel involved in their care.

Complete and contemporaneous records were not always in place. Accident and incident records were incomplete and did not always evidence the action taken to prevent similar events happening again.

People’s se

This inspection took place on 3 and 11 August 2017 and was unannounced. Queen’s Oak Care Centre was previously inspected on 30 June 2015 and was rated ‘Good’ in each domain inspected.

Queen’s Oak Care Centre offers nursing and personal care for up to 89 older people. At the time of the inspection there were 77 people using the service. The premises are purpose built and wheelchair accessible.

The service has 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.

We have made one recommendation which you can find in the full report, relating to management of confidential documents.

People did not always have their confidentiality maintained as records were not always stored securely.

People were protected against the risk of abuse as staff received on-going training in safeguarding and knew how to identify different types of abuse and appropriately escalate their concerns. Staff were aware of the whistleblowing policy.

The service deployed sufficient numbers of suitably vetted staff to meet people’s needs safely. Records confirmed robust pre-employment checks were carried out to check staff’s suitability.

People received their medicines safely and in line with good practice. Systems and processes in place ensured medicines were stored, recorded and disposed of safely.

The service provided staff with comprehensive training programmes to effectively meet people’s needs. The induction programme provided by the service ensured staff were competent in carrying out their roles and responsibilities in line with the provider’s expectations. Staff continually reflected on their working practice through regular supervisions and annual training.

People were supported to access healthcare professional services as and when required and staff followed guidance provided. People had access to food and drink that reflected their preferences and nutritional needs.

People were encouraged to maintain relationships with people that were important to them. The service welcomed friends and visitors with no restrictions. People’s views of the service were sought and consent to care and treatment given, prior to care being delivered. People had their privacy respected and their dignity maintained. The service encouraged equality and diversity to ensure people were able to express their views and live the way they chose.

Care delivered was personalised and responsive to their needs. Care plans were comprehensive and regularly reviewed and updated to reflect changes to people’s needs. Where possible people were encouraged to participate and lead the development of their care plans.

The service had a complaints process that actively encouraged people to share their views and complaints. Records showed complaints were investigated with healthcare professionals input sought where appropriate.

People were supported in a service that was transparent and inclusive for all. People spoke highly of the registered manager and told us they found her approachable, fair and interested in both people and staff’s views.

The registered manager carried out audits of the service to improve quality, audits looked at care plans, risk assessments, medicines, maintenance and staff. Quality assurance questionnaires were sent to people and their relatives to gather feedback.

The registered manager actively sought partnership working to drive improvements. Healthcare professionals told us the registered manager took on board guidance and support and implemented this into the delivery of care provided.

The inspection took place on 30 June 2015 and was unannounced. Our last inspection took place on 5 November 2013. We found at that inspection that the home was meeting the regulations inspected.

Queen`s Oak Care Centre provides nursing and personal care for up to 88 older people, some of whom are living with dementia. At the time of our inspection there were 83 people living at the home.

The home had a registered manager. 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.

People received safe care as risks were assessed and managed. Staff were knowledgeable about keeping people safe from abuse and how to report concerns.

People received their medicines when they required them.

Staff were well supported and trained to undertake their roles. They referred people to specialists if they needed additional health support and followed advice provided.

People enjoyed their meals and they were designed to meet their health, nutritional and cultural needs. Staff provided people with enough to eat and drink.

People and their relatives said staff were caring and compassionate. They had the opportunity to give their views about how they liked to be cared for. People’s privacy and dignity were protected. Staff provided good quality care at the end of people’s lives, taking their wishes into account.

Staff provided care which addressed people’s individual needs. People had the opportunity to join in activities which had been designed to reflect their interests.

The home was managed well and checks were made by the manager and the provider to make sure good care was provided.

We met with all 83 people present at Queens Oak during our inspection visit. We spoke with four of the relatives visiting and with a visiting health practitioner.

We saw people who were at risk of falling being assisted by staff to move between rooms in a manner that gave them security and confidence.

A relative present told of the distress their parent experienced on occasions prior to coming to the home due to advancing dementia. They said “staff know how to care for people properly and reassure people with dementia, my mother is contented and settled in the home."

We saw a file of thanks and compliments about Queens Oak; one described the service as “top notch.”

A member of staff said that they wanted to do a good job to help people living at Queens Oak “you just imagine if it was your Mum or Dad, you would want the best for them, so we want the best for our people too.”

The service was effectively led, and this ensured a competent skilled staff team was present to provide the consistency of care people needed.

A number of the people who lived at this care home had various forms of dementia which meant they were not always able to communicate verbally with us in a meaningful way. During the day we used at intervals the Short Observational Framework for

Inspection (SOFI). We also gathered evidence of people's experiences of the service by speaking with 7 relatives, and stakeholders.

The feedback received from people living at Queens Oak and from visiting relatives was positive. Visitors described their confidence in the expertise demonstrated by staff in the way they cared for people with dementia. One person said " I am now able to be part of my partner's life since they they moved to this home, I understand from staff the importance of touch and sound in a person's life when they can no longer speak".

Staff received specialist training that enabled them respond appropriately to the needs of the people they cared for. Staffing levels enabled people using the service experience a positive sense of wellbeing. One person said "There is always someone nearby to help me, the support I get is at a pace that suits me, I am slow with my movements but staff are patient and never rush the tasks".

Activity programmes were varied and acknowledged individual capacities and abilities, they were tailored to individual needs and offered people appropriate stimulation.

People told us that the staff were kind and helpful and that they liked living in such a lovely homely environment.

People were enjoying participating in a range of activities during the day and were in a jovial mood. Some very active residents kept themselves busy by doing household chores such as preparing dining tables for meals.

A person who uses the service told us that they liked to go out and had enjoyed a recent outing to Eastbourne.

Some people told us of the importance of their religious belief and said that they are glad to have the opportunity to attend church services.

People told us that the staff were kind and helpful. A relative visiting told us that her mother was in the best place, she was happy and settled as staff were kind. Another relative said that staff kept the family up to date with any changes in their mother's condition.

Staff told us that they feel well supported and enjoyed their work. Several people said that they received a lot of useful training courses and that their skills were kept up to date.