The inspection took place on 6 December 2018 and was unannounced.

The Queens Residential Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to accommodate 46 older people, some of whom may be living with dementia. There were 38 people living at the home at the time of the inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People living at the service were protected from avoidable harm as staff received training and understood how to recognise signs of abuse and the who to report this to if abuse was suspected.

Risks to people were identified and plans were put in place to help manage the risk and minimise them occurring.

People received their medicines safely. Staff competencies around administering medicines were regularly checked. Checks on medicines were undertaken, however there wasn't a clear record of the amount of medicine stock held for each person. The registered manager assured us they would implement this.

People told us, and we saw there were enough staff on duty to meet their needs. We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work.

People were supported by a team of staff who were knowledgeable about people's likes, dislikes and preferences. People received care and support from a staff team that was provided with continual learning that enabled them to carry out their role effectively. Staff told us they felt supported and happy in their work.

The home was clean and tidy. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety was maintained. We noted that some areas of the environment needed attention such as paintwork on skirting boards and door frames. The registered manager gave us assurances that the redecoration of these areas would take place within six months.

Appropriate personal protective equipment and hand washing facilities were available. Staff had completed infection control training.

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 supported this practice.

People told us they enjoyed the food provided. Staff supported people to maintain their health and attend routine healthcare appointments.

People who used the service told us that staff were kind and caring. Care plans we reviewed, detailed people's needs and preferences and were reviewed on a regular basis to ensure they contained up to date information.

People had access to a range of activities, and were provided with opportunities for social stimulation.

The service had a clear procedure for handling complaints.

Quality assurance processes were in place and regularly carried out to monitor and improve the quality of the service. Although accidents and incidents were thoroughly recorded the registered manager did not analyse these regularly or in detail to identify any trends and patterns. The registered manager agreed to implement more frequent evaluation of accidents and incidents at the service.

Feedback was sought from people who used the service through meetings and surveys.

Further information is in the detailed findings below.

The Queens is a residential care home. It provides personal care and accommodation for up to 46 older people and people who may be living with dementia. The service is a large detached building and accommodation is provided over two floors. The service is located in the seaside town of Withernsea, close to the town centre and the sea front. The registered provider is Chapter Care Limited.

We inspected this service on 22 June 2016. This inspection was unannounced. At the time of our inspection there were 31 people using this service.

The service was last inspected in August 2014 at which time it was compliant with all the regulations we assessed.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). 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.

During this inspection we saw that there were sufficient numbers of staff employed to meet people's individual needs. New staff had been employed following robust recruitment and selection policies and this ensured that only people considered suitable to work with vulnerable people were working at The Queens.

People told us that they felt safe living at the service. People were protected from the risks of harm or abuse because there were effective systems in place to manage any safeguarding concerns. The registered manager and care staff understood their responsibilities in respect of protecting people from the risk of harm.

We checked medication systems and saw that medicines were stored, recorded and administered safely.

Staff received effective training and supervision to support them in their role. The registered provider and registered manager were taking additional steps towards further developing staff knowledge to improve staff knowledge in regards to dementia care.

People were supported to make decisions in line with relevant legislation.

People's nutritional needs had been assessed and people told us they were very happy with the food provided. We observed that people's individual food and drink requirements were met.

Staff were observed to be kind and caring. We observed that staff had developed meaningful caring relationships with the people they supported and people’s privacy and dignity was respected.

We saw that there were systems in place to assess and record people’s needs so that staff could provide personalised care and support. Care files were updated regularly and information shared so that staff were aware of changing needs.

Care staff and people who lived at the service told us that the service was well managed. People told us they would not hesitate to express concerns or make a complaint, and they were confident their concerns would be listened to and acted on. There was a process in place to manage complaints that were received by the service. In addition to this, there were systems in place to seek feedback from people who lived at the service, relatives and staff.

Quality audits were undertaken of the systems within the service to help make sure people’s needs were safely met.

At our last inspection of the service in May 2014 we issued the provider with two compliance actions. Our inspector visited the service to see what action the provider had taken to become compliant with regulations 12 and 15 of the Health and Social Care Act 2008. The information collected by the inspector helped answer one of our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? 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 staff and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Improvements to prevention and control of infection practices within the service had been made so the service was safe, clean and hygienic.

The provider ensured the environment was regularly maintained, safe and fit for purpose. Improvements had been made to ensure areas of the home that required repairs, decoration and refurbishment had been addressed. The provider had carried out an environmental audit and the outcomes of this were being used as part of the quality assurance process to improve the service for people who lived in the home.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable

Is the service responsive?

Not applicable.

Is the service well-led?

Not applicable.

We carried out this inspection to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? 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.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were treated with respect and dignity and we observed caring and compassionate care by the staff. People told us they felt safe. People had their own care file and these contained an assessment of needs for example; a personalised care plan, life history, key worker monthly reviews, annual reviews and daily record of care needs.

There were activities for people to be involved in to give them stimulation and a choice about their welfare.

We saw that the service needed to address its infection control practices as we found examples of poor practice in some parts of the home and some furniture was dirty and in need of a deep clean. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to infection control.

We also saw that the service needed to ensure the environment and the building was maintained to ensure people were kept safe. We saw examples of plaster flaking form walls, water ingress and inadequately maintained carpet areas that could cause potential trip hazards. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the environment and health and safety.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support. People were spoken to in a friendly and professional way. Comments included, “They ask your permission and knock on doors” and “Staff ask me questions and talk to me about support they give me and I give them my permission.”

A GP who was visiting the service told us, “I have been visiting this service for some time and it’s a nice feeling when the staff know about peoples medical and life history and they know them personally as real people.”

Care files were checked on a monthly basis by the manager and key worker and annual reviews took place to ensure care needs were continuing to be met.

“All staff have a supervision meeting twice a year where training requirements were discussed. There was a training plan in place which ensured all staff had refresher training in a planned way.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were supportive and attentive to people’s needs, and were professional and courteous. People commented, “I am fully independent and can support my own needs but staff will always give me assistance, I just need to ask them”, “Staff are very good to me and they are always polite and treat me with dignity and respect” and “If I ring my call bell staff come to my assistance, I don’t have to wait long.”

A health care professional was visiting on the day of the inspection. They told us, “The staff are very caring and they provide genuine care. I see the staff out and about in the town with residents and activities with them are constantly happening. I have seen residents using ‘Skype’, using email, bowling and sometimes they have singers on too.”

Is the service responsive?

People regularly completed a range of activities both in and away from the service. Different events and activities were available for people to take part in. We observed bun making taking place and people positively engaged in the activity. During our observation, we also saw a person enjoying doll therapy and another person enjoying a game of snakes and ladders on the computer. We also observed a person with their family member on Skype, having a conversation with another family member who lived abroad.

Visiting relatives of people that used the service told us, “The staff are wonderful, they are very good and always make me feel welcome when I come here to visit my partner” and “My mum gets very good care and support from the home, it’s lovely here.”

People knew how to make a complaint if they were unhappy. We looked at how these complaints had been dealt with, and found that the response had been open, thorough, and timely. People were therefore assured that complaints were investigated and action was taken as necessary.

Is the service well-led?

Pre-admission records completed by the manager and in some cases, the local authority detailed people’s needs prior to service commencing at the home. As a result of this people were supported and cared for as they expected.

The service had an effective quality assurance system in place and records seen by us showed that identified shortfalls were addressed promptly. Records we looked at included responses from people who used the service, relatives and other health care professionals.

The staff we spoke with knew about their involvement with team meetings. They told us, “I have been in a caring role for years and this service is top notch. The people and staff are warm and friendly and everyone treats you with respect”

Staff had a good understanding of the procedures and policies that were in place. This helped to ensure that people received a good quality service at all times.

We spoke with the provider, the manager, the deputy manager, two members of staff, two people who lived at the home and a health care professional during this inspection.

People who lived at the home told us that they were happy with the support they received. We observed positive interaction between people and staff. One person told us, “Staff are very good – they are respectful and speak nicely to us. I am very satisfied with the care here”.

We saw that safeguarding allegations had been dealt with professionally by the manager. Staff who we spoke with displayed a good understanding of the different types of abuse and were able to explain the action they would take if they observed any poor practice or incidents of abuse.

Medication was handled in a safe way. Minor concerns that were identified during the inspection were acknowledged by staff and improvements were made straight away.

There was an on-going refurbishment programme in place; we saw that some areas of the home were in need of decoration and that some carpets needed to be replaced. The manager told us that carpets had already been purchased and the provider told us that this work would be completed within three months of this inspection. Improvements had been made to toilet facilities, some bedrooms and access for people with mobility problems.

There were sufficient numbers of staff employed and there were quality monitoring systems in place to ensure that a high quality service was maintained.

People told us what it was like to live at this home, they described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service and a practising professional.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People told us the staff treated them with respect and maintained their dignity. They told us that they had choices in the home and could choose whether to participate in activities or to spend time on their own.

One person told us that the staff were “Calm and attentive” and felt all of their needs were met with the home being “Excellent”.