We carried out an unannounced inspection of the service on 6 November 2018. Queenswood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service supports older people.

Queenswood accommodates up to 41 people in one building. At the time of our inspection there were 31 people living at the home. This is the service’s third inspection under its current registration. At the previous inspection on 7 February 2017 we rated the service as Requires Improvement. We also identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection we checked to see if improvements had been made and we found they had. The service has now improved from Requires Improvement to Good overall.

A registered manager was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (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.

People were supported by staff who understood how to protect them from avoidable harm. Risks to people’s safety were assessed and acted on. There were enough staff in place to support people and to keep them safe. People’s medicines were managed safely. The home was clean and tidy and staff understood how to reduce the risk of the spread of infection. Accidents and incidents were regularly reviewed, assessed and investigated by the registered manager and the provider’s senior management team.

People’s physical, mental health and social needs were assessed and met in line with current legislation and best practice guidelines. Staff received regular training and their practice was assessed. Staff felt supported by the registered manager. People were supported to follow a healthy and balanced diet. People had access to external health and social care agencies. The home environment was well maintained and adapted to support people living with a physical disability or living with dementia. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People liked the staff and found them to be kind and caring. Staff treated people with dignity and respect and people’s privacy was respected. People were supported by staff who understood their needs and supported them with making decisions about their care. People’s diverse needs were respected including promoting people’s access to religious and spiritual guidance. People were encouraged to lead as independent a life as possible. People were provided with information about how they could access independent advocates. There were no restrictions on people’s friends or relatives visiting them. People’s records were handled appropriately and in line with the General Data Protection Regulations.

People care records were person centred and they received care from staff in line with their personal preferences. Care records were regularly reviewed to ensure they continued to meet people’s changing needs. People were treated fairly, without discrimination and systems were in place to support people who had communication needs. Records showed complaints had been dealt with appropriately. People were supported to make decisions about how they wished to be cared for at the end of their life.

The registered manager had made improvements to the home since the last inspection. Robust quality assurances processes were now in place and helped to assure the registered manager that areas for improvement were identified and acted on in good time.

We inspected the service on 7 February 2017. The inspection was unannounced. Queenswood provides accommodation for up to 41 older people. On the day of our inspection 38 people were using the service.

The service did not have a registered manager in place at the time of our inspection. 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 registered manager had recently deregistered with us and the provider was in the process of recruiting a new manager.

We carried out an unannounced inspection of this service on 23 February 2016 and a breach of legal requirement was found in relation to having systems in place to assess, monitor and make improvements to the service. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan and we looked at whether the improvements had been made during this visit. We found that some improvements had been made but these had not been sustained and the systems were still not fully effective in bringing about the required changes in the service.

Staff were not always deployed in a way which ensured people’s requests were responded to in a timely way. People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. People were given their prescribed medicines.

People were not supported to eat enough. There were no systems in place to assess if people would need an application for a Mental Capacity Act 2005 Deprivation of Liberty Safeguard. People were supported to make decisions, and people who lacked the capacity to make certain decisions were supported with this. People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

People were supported with risks relating to their health needs. Referrals were made to external professionals when people’s health needs changed and they were supported to attend appointments.

People were treated with respect and cared for by staff who recognised the importance of spiritual and emotional wellbeing. People were involved in planning their care and support and were supported to live as independently as possible. People enjoyed an active social life and were supported to maintain and develop their hobbies and interests.

Systems in place to monitor and improve the quality of the service provided were not always effective in identifying and bringing about improvements needed. People were given the opportunity to have a say in how the service was run.

We inspected the service on 23 February 2016. The inspection was unannounced. Queenswood provides accommodation for up to 41 older people. On the day of our inspection 40 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 carried out an unannounced inspection of this service on 14 April 2015. A breach of legal requirement was found in relation to having sufficient numbers of staff deployed in the service. We told the provider they must send us a written plan setting out how they would make the improvements and by when. The provider sent us an action plan on 28 July 2015 and told us they had made the improvements and complied with the regulation as of 22 July 2015.

We found that the registered manager had failed to make all of the improvements in relation to staffing levels in the service. Although the provider had increased the staffing levels at night, staff were not being deployed in a way which would ensure people received care and support in a timely way during the day. The dependency of people had not been assessed against the current staffing levels.

Medicines were not always managed safely to ensure people received their medicines as prescribed.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm.

People were supported to make decisions, however where people did not have the capacity to make certain decisions, they were not fully protected under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

People were not always supported to maintain their nutrition and were not always supported with known risks relating to their health needs. Referrals were made to external professionals when people’s needs changed and people were supported to attend appointments.

People were treated with respect and cared for by staff who recognised the importance of spiritual and emotional wellbeing. People were involved in planning their care and support and were supported to live as independently as possible. People enjoyed an active social life and were supported to maintain and develop their hobbies and interests.

People may not be able to express themselves because the service did not have an open and inclusive culture. Systems in place to monitor and improve the quality of the service provided were not always effective in identifying and bringing about improvements needed. People were given the opportunity to have a say in how the service was run but when improvements or changes they suggested were made these were not always maintained.

You can see what action we told the provider to take at the back of the full version of the report.

We inspected the service on 14 April 2015. The inspection was unannounced. Queenswood provides accommodation for up to 41 older people. On the day of our inspection 37 people were using the service.

The service had a registered manager in place at the time of our inspection. 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 did not always receive care and support when they needed it as there were not always enough staff deployed in the service to deliver this is a timely way. People were not always protected against the risk of falling when they were at high risk.

People felt safe in the service and the manager shared information with the local authority when needed. Staff knew how to respond to incidents if the manager was not in the service. This meant there were systems in place to protect people from the risk of abuse.

Medicines were managed safely and people received their medicines as prescribed. People were supported by staff who had the knowledge and skills to provide safe and appropriate care and support.

People were supported to make decisions about their care and treatment and where a person lacked the capacity to make a certain decision, their rights were protected. People were supported to maintain their health needs. Referrals were made to health care professionals for additional support or guidance if people’s health changed.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people. People enjoyed the activities and social stimulation they were offered. People also knew who to speak with if they had any concerns they wished to raise and they felt these would be taken seriously.

People were involved in giving their views on how the service was run through the systems used to monitor the quality of the service. Audits had been completed that resulted in the manager implementing action plans to improve the service.

People using the service spoke positively about the support they received from staff. Everyone we spoke with told us their needs were met and they were happy and settled living at the home. One person said, “The staff are very nice, I am well looked after. After I had been to the hospital they knew what sort of diet that I needed and I get it.” Another person said, “”It is very nice; staff offer me reassurance and support if I need it. They are respectful at all times.”

One relative told us they were very happy with the care and support their relative received at the home. They said, “You can’t get any better than this, my [relative] is very well looked after and the staff are wonderful.”

We saw that staff were readily available to help people when needed and they supported people with compassion and respect at all times.

People spoken with told us they felt there were sufficient staff available to meet their needs. One person said, “The staff are very nice and pleasant, I don’t need help, but I have seen that people do not have to wait long for assistance.” Another person said, “I am well looked after, I sometimes have to wait but it is understandable as there are 40 of us, but it’s never for long. If I ring my buzzer they come fairly quickly.”

We found the provider had effective quality assurance systems in place to ensure people received a quality service.

We found that people who use the service, their representatives and staff were asked for their views about their care and treatment and these were acted upon.

Everyone we spoke with told us they were able to make their own choices and decisions. One person told us how they had gone out for a walk that morning to get some fresh air and another told us they enjoyed reading, therefore they spent their time doing that rather than other activities.

People told us that staff were kind and respectful at all times. One person said, “The staff always respect my privacy and dignity, they knock on doors before they come in and they are respectful.” Another person said, “The staff are definitely respectful, they are very caring.”

People using the service spoke positively about the care they received from staff. One person said, “The staff are excellent, they really look after me. I can maintain my independence but they help me when needed.” Another person said, “The staff are lovely and they help me as needed.”

The people we spoke with told us they felt safe and the manager and staff were approachable and would listen to any concerns they may have. One person said, “I haven’t even thought of complaining as I am so settled here. If I did have any problems I could speak with the manager or the deputy manager, I am sure they would listen and sort things out.” Another person said, “If I had any problems I would tell the staff and they would listen to me.”

We spoke with 15 people living at Queenswood.

They all said that life in Queenswood was very pleasant.

““It’s lovely here. The food’s good. I’ve got no complaints.”

“The beds are kept nice.”

“My new bedroom is wonderful and it has made me so much more independent.” “They put entertainments on. I like the quizzes and the chair exercises.”

“It’s nice and big, not closed in and the gardens are nice.”

“It’s very good, I’m happy here, it’s modern. It’s a very good place to be.”

“The food’s good, I’ve got a nice room, I’ve no complaints.”

Concerning the staff everyone said that the staff were kind and cared well for them. One person said: “They’re all nice that work here.”

Concerning the meals and the restaurant everyone said that the food was very good. One person said: “The food is very good indeed.”