About the service:

Queensbridge House is a residential care home. It specialises in the care of people who live with dementia and mental health needs. It can accommodate up to 27 people, although at the time of the inspection 26 people were receiving care (a bedroom which can accommodate a couple where needed was being used by one person).

People’s experience of using this service:

• The service demonstrated a strong, visible person-centred culture and followed a model of dementia care called the ‘Butterfly Approach’. People therefore received highly personalised and exceptionally caring, kind and empathic care from staff

• People’s feelings, wishes and wellbeing were at the centre of their support. People were afforded time and emotional support to help them maintain their wellbeing. Staff were particularly ‘tuned into’ people’s moments of illbeing and distress and provided positive and emotional support at these times.

• Staff demonstrated exceptional compassion, understanding and kindness towards people when supporting them. A nurturing culture helped people to feel safe and to develop meaningful and beneficial relationships.

• Staff were developed and supported to be skilled and motivated in helping people to live well with dementia. Improving people’s quality of life was at the centre of all interactions and activities provided by the staff.

• Activities were meaningful and fun, they were person - centred and were aimed at maintaining individual skills and achieving a sense of purpose and achievement. They were used to support social connections between people.

• People and staff lived and worked as one supportive ‘household’ caring for and valuing each other’s contribution. Staff recognised and valued the importance of those who were close to people; family and friends. They were supported to feel part of the ‘household’ and to remain part of people’s lives.

• People’s representatives (where appropriate) contributed to people’s care and the decisions made on their behalf.

• The home’s environment was domesticated and adapted to help people orientate and connect to their surroundings.

• People’s care records had improved. Records reflected people’s needs, the care people received and gave detailed guidance to staff on how to meet people’s needs.

• Risks to people were identified, assessed and managed effectively. We have made a recommendation in relation to guidance available to staff when supporting people following a fall who have also sustained a head injury and who are on a blood thinning agent.

• People and their relatives benefited from the home being managed in an open and transparent way. There had been a change of manager in August 2017 when the deputy manager became the registered manager of the service.

Rating at last inspection:

At the last inspection on 26 and 27 October 2017 the service was rated Requires Improvement. This report was published on 2 February 2018.

At our last inspection we found people’s records were not always comprehensive and the provider’s quality assurance systems had not identified this concern. Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key questions, Is the service responsive and well-led? The overall rating for the service has improved from Requires Improvement to Good.

Why we inspected:

We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous Requires Improvement rating. We also followed up on progress against agreed action plans to address the breaches in regulation we found at our previous inspection in October 2017. Previous CQC ratings and the time since the last inspection were also taken into consideration.

The overall rating for the service has improved from Requires Improvement to Good.

Follow up:

We will continue to monitor intelligence we receive about the service until we retu

This inspection took place on 26 and 27 October 2017 and was unannounced. Queensbridge House provides accommodation for 27 people who require personal care. There were 24 people were living in the home at the time of our inspection. The home provided personal care and support for people who live with dementia.

Queensbridge House is set over two floors. It has four lounge/dining room areas with a variety of seating and objects of interest and a secure back garden. The home also offers a day centre service.

A registered manager was in place as required by their conditions of registration. A second manager had also recently registered with CQC to support the established registered manager in managing the home. 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 the last inspection in September 2016 we rated the service as ‘Requires improvement’. As a result of this inspection, we found the service had not improved in its rating and continues to be rated as ‘Requires improvement’. Under Regulation 17(3) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we will be asking the provider to send us a written report of the action they plan to take to achieve a rating higher than ‘Requires Improvement’ to support us to monitor the provider’s planned improvements.

People received care and support from staff who were knowledgeable about their support needs and preferences. However people’s care records did not always provide staff with the information they needed to support people. The records of the management and monitoring people‘s risks and their medicines did not provide staff with sufficient guidance. People’s consent to their care or the outcome of mental capacity assessments were not reflected clearly in people’s care plans. Records showed that people’s health care needs were monitored and any changes in their health or well-being had prompted a referral to their GP or other health care professionals.

Relatives highly praised the caring nature of staff and told us they were always welcomed at the home. There were many warm and genuine interactions between staff and people. Staff treated people with dignity and respect. People and their relatives told us they felt safe living at the home. They told us they enjoyed their meals and were supported to eat a healthy diet and have plenty to drink. People enjoyed activities in the home.

Staff had been trained in their role and felt supported by the managers. The registered managers worked alongside staff providing care which gave them a good insight into people’s needs and skills of staff, although their assessment and observations of staff were not effectively recorded or monitored. Staff were aware of their responsibilities to report any concerns of abuse or harm. There were sufficient numbers of staff who had been suitably recruited to support people.

A new management structure provided people and staff with confidence in the management of the home. People and their relatives were confident that any concerns would be dealt with promptly. Quality assurance systems were being implemented and reviewed to evaluate the quality of care being delivered, although had not identified gaps in the details of people’s care records. We have recommended that the service reviews the systems that monitor people’s care records.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what action we told the provider to take at the back of the full version of this report.

.This inspection took place on 19 September 2016 and was unannounced. Queensbridge House provides accommodation for 27 people who require personal care. There were 21 people were living in the home at the time of our inspection. The home provided personal care and support for people who live with dementia.

Queensbridge House is set over two floors. It has four lounge/dining room areas with a variety of seating and objects of interest and a secure back garden. The home also offers a day centre service.

A registered manager was in place as required by their conditions of registration. 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 told us they enjoyed living at Queensbridge House. Relatives were complimentary about the caring nature of staff. Staff approached people in a kind and caring manner. They had all been trained in the ‘Butterfly Approach’ which is a way of supporting people living with dementia by focussing on their emotional needs. Staff ensured people received care and support in accordance to their preferences and needs. People’s privacy and dignity was respected.

There were sufficient amount of staff to meet people’s needs. Staff told us they felt supported and well trained, although they had not consistently received regular private support meetings or staff meetings. The registered manager was actively recruiting new staff. Safe recruitment practices where followed to ensure suitable staff were employed, although we have made a recommendation about safe recruitment practices.

People’s care and support needs were documented. People were supported by staff who respected their human rights and encouraged them to make decisions about their care. They were provided with a variety of activities to meet their social needs. Staff were confident about recognising and reporting suspected allegations of abuse although they were not always clear about who they would report their concerns to outside the organisation.

There were safe systems in place to manage people’s medicines. People received their medicines on time by staff who were trained to carry out this role. People’s care records showed relevant health and social care professionals were involved with people’s care. Peoples nutritional and hydration needs were appropriately assessed and monitored. People’s specialist dietary needs were catered for.

Quality monitoring systems were in place to identify any shortfalls in the service although the processes lacked evidence if actions had been taken to address the areas of concern. The registered manager sought feedback from people however there was no evidence that the results of the feedback had been acted on.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out an announced comprehensive inspection of this service on 10 and 13 April 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) gaining people’s lawful consent to their care and support; Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) managing people’s risks and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) supporting and training staff.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Queensbridge House on our website at www.cqc.org.uk.

This focused inspection took place on 30 October 2015 and was unannounced. Queensbridge House provides accommodation for 27 people who require nursing and personal care. 21 people were living in the home at the time of our inspection. Most of the people living in the home have been diagnosed with a type of dementia.

The provider and registered manager of Queensbridge House had introduced and planned several changes to the home to ensure people who lived there remained safe and had a good quality of life. The registered manager had sought specialist advice on running a home for people with dementia and had reviewed the format of people’s care records.

Staff were kind and their care and approach focused on people’s needs and preferences. People’s health care risks were now being routinely identified however records of how people should be supported to reduce the risks were not always consistent. Some people had not been assessed for the support they would require in the event of a fire. Staff supported people who lacked mental capacity with choices about their day. However the documentation of the assessment of people’s mental capacity had not been completed in line with legislative guidance.

Staff had now received update training. Their training needs and personal development was now being monitored. A one year programme was in place to provide all staff with additional training on dementia awareness. Staff had started to receive regular support meetings. Further plans were in place to review how staff would be supported in the future.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People said that they were able to make choices about their personal care and make choices about the food that they had.

People in the home and their relatives said that the care was good. The individuals who used services said that they felt safe and secure and listened to. People living in the home that if they had any concerns they felt they could go to the manager and these concerns would be dealt with.

We observed that appropriate assistance was being received by individuals when required.

Surveys were being undertaken to seek the views of people using the service but these required development into a clear audit trail of evidence.

Staff training and support was in place to ensure that the individuals were being cared for by appropriately trained and supervised staff.

We visited this home in response to information of concern. The focus of our visit was the arrangements for the administering of medication.

Queensbridge House provides care predominately to people who have dementia. Because of this we were only able to speak to a small number of people.

People we spoke with told us, "staff are friendly here", "its all very good", "its great, they look after you". One person told us, "I like it, the food is good, I enjoy the food" and another person said, "I always enjoy what I eat".

This inspection took place on 10 April 2015 and was unannounced. Queensbridge House provides accommodation for 27 people who require nursing and personal care. 24 people were living in the home at the time of our inspection. Most of the people living in the home have been diagnosed with a type of dementia. This service was last inspected in November 2013 when it met all the legal requirements associated with the Health and Social Care Act 2008.

Queensbridge House is mainly set over two floors which are accessible by stairs or a lift. A further three bedrooms and the main office is set on a third floor. The home has two lounges, a dining room and a conservatory. People have access to a private secure back garden.

A registered manager was in place as required by their conditions of registration. 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 2014 and associated regulations about how the service is run.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

People and their relatives were positive about the care they received however we found people’s safety and well-being was compromised in a number of areas. Although staff had a good understanding of people and responded to their physical and emotional needs; some people’s individual risks were not being assessed fully or monitored. Staff inputted ‘real time’ information about people’s daily lives and activities in to the electronic care planning system. However, staff were unable to access this information and collectively read about the overall well-being of people which would give them guidance.

People’s medicines were not managed effectively. The record balance of prescribed and over the counter medicines stored in the home was not accurate. Staff had not been given a recent refresher course in the administering and managing medicines to ensure their practices were current. We have made a recommendation about good practices of managing people’s medicines and the training of staff.

Staff were knowledgeable about recognising the signs of abuse. There were sufficient numbers of staff to meet people needs although there were gaps in some of the staff recruitment processes which are intended to ensure the suitably of staff was checked before they care for people. Formal support and training for staff was not effectively managed and monitored to ensure people were being cared for by staff with the appropriate skills.

Staff knew people well enough to understand their preferences; however they were not familiar with the Mental Capacity Act 2005 and their legal responsibility on how to support people who lacked capacity. Some people’s mental capacity to make day to day or significant decisions had been assessed or recorded but the records were not clear and accessible to staff.

People and their relatives were positive about the care and support they received from staff. They were supported to maintain their health and well-being and access additional care and treatment from other health care services when needed. People who had specific dietary needs were catered for. Most people ate in the dining room however the dining experience for some people was restrictive. Other people chose to eat from individual tables in the lounges although the table heights were not ideal to eat from. The home’s environment was safe but it did not support people with dementia and help to orientate them to overcome their lack of memory. We have made a recommendation about creating a home environment which supports people living with dementia.

The home had recently been taken over by a new provider who had proposed changes to the structure of the building. Some quality assurance audits were carried out by the registered manager; however there were no quality audits carried out by the new provider. The home’s policies had not been updated to reflect current legal practices and the protocols of the home.