We inspected Queensway on 25 January 2017. The visit was announced. Our last inspection took place in May 2015 where we identified a breach of legal requirements which related to safe and care treatment in medicine management. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations and a clear time frame in which they would complete this. On this visit we checked and found improvements had been made in all of the required areas.

Queensway is a care home. The home can accommodate up to six people with learning disabilities. It consists of living and communal accommodation over two floors and has an enclosed garden.

At the time of our inspection the service 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.

Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. Risk was well managed and were the least restrictive for people. There were enough staff to keep people safe.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in medicines management.

People’s needs were met by staff who had the right skills, competencies and knowledge. Systems were in place to support staff to do their job well formal supervisions were in place. All staff had completed an appraisal.

Health, care and support needs were assessed and met by regular contact with health professionals. However in two care plans people were overdue on an optician’s appointment. The registered manager booked these in at the time of our inspection. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People told us they were happy living at the home and enjoyed the company of staff and others they lived with. People were supported to make decisions and received consistent, person centred care and support. However, Daily records were not always effective due to areas of information missing from these.

The service had good management and leadership. Relatives and stakeholders got opportunity to comment on the quality of service and influence service delivery. Effective systems were in place that ensured people received safe quality care.

The inspection of Queensway took place on 5 May 2015 and was unannounced. We previously inspected the service in December 2013 and found the service to be meeting the regulations we checked at that time.

Queensway is a care home with nursing. The home can accommodate up to six people aged between 18 and 65 with complex cognitive disabilities and verbal communication difficulties. It consists of living and communal accommodation over two floors and has an enclosed garden.

People were safe and staff were providing support when needed and had a sound understanding of what constituted a safeguarding concern. It was evident throughout the day of our inspection that staff knew the people well, and responded to their specific needs.

We found that medicines management was problematic as stock levels did not always tally, and there had been no action on securing replacement medicines for people after a medicine cupboard lock had broken which prevented access to these medicines.

The service had adequate staffing levels on the day of our inspection but we found there was a reliance on agency staff, particularly for nurses. This meant that permanent staff were having to spend considerable time with the agency staff explaining people’s needs and also that the people living at Queensway with complex needs were having to get to know lots of different people which lacked continuity for people and could become unsettling for them.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. The service demonstrated knowledge of the importance of seeking consent and ensuring they were acting in people’s best interests. This was appropriately documented and observations throughout the day further evidenced this embedded practice.

Staff were caring and had positive relationships with people in the home. It was evident permanent staff knew people well and were able to have a good rapport with people. The atmosphere was relaxed throughout the day and people’s wishes were always respected, whether this was in food choice, activity or in receiving personal care support. It was evident that the home belonged to the people living there as the days were shaped by their preferences. Staff were clearly there to support and guide people with gentle prompts, always allowing them to make their own decisions.

There was a registered manager who had been registered since November 2014. 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. They were only on site two days a week so there was a heavy reliance on the deputy manager. It was clear the home was well managed as it was calm and welcoming, and people were settled.

While we saw evidence of effective systems in place for picking up issues for individuals within the home, such as when they needed increased support due to health concerns, we saw little service-wide monitoring of how the home was ensuring quality.

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

People who used the service could not communicate clearly so we observed staff providing support and listened to their interactions. We spoke with five staff about the people who used the service and we looked at care plans. This gave us assurances that staff knew the needs of people and knew how to deliver the care and support effectively.

Our observations of the service showed that care staff spoke with and interacted with people who used the service in a patient and pleasant manner. Care staff supported people in a sensitive way using differing methods of communication to ensure that people who used the service understood what was going to happen.

The people who used the service appeared happy and comfortable with their surroundings. They appeared to be relaxed with the staff in their interactions with them. We noted that people who used the service had access to a wide range of activities which were personalised to their individual needs and documented clearly in the care plans. We spoke with on person who used the service he told us he was ‘happy’ with his care.

Each of the bedrooms belonging to the people who used the service were personalised and we saw staff knock on the door before entering a person’s bedroom.

Report writing in the care records reflected the changes in care and treatment that people received. We also found that staff were supported and monitored in their working practice and had training and appraisals programmes in place.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to and observed staff interaction with the people who used the service and we looked at care plans.

Staff we spoke to told us that they enjoyed working at the home. They felt they were supported by management and they received regular training. We saw from the staff files we looked at that staff received regular supervision and were appraised annually.

The staff we spoke to told us they thought people were treated with respect and dignity. We saw that interaction between the staff and the people who used the service was positive.

Staff told us that annual satisfaction questionnaires were carried out at the home, they would use pictures and signs to help the people who use the service express their views.

We looked at people's care plans and saw that care was planned in a way that ensured their health and well being. We saw that risk assessments had been reviewed and were up to date.

Staff told us that the quality of service was monitored by the service provider through monthly audits. The provider carried out annual stakeholder satisfaction questionnaires. The staff we spoke to had training in safeguarding and we saw that there were policies and procedures in place to support staff.