Queensbridge House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

The service has shown improvements in prioritising safety and embedding a culture of openness and collaboration. The provider had improved their processes to learn and make improvements when people raised concerns about safety. Services were planned and organised with people and their representatives which improved their safety across their care journey. Supporting people to balance risks of harm when making choices about their lives had improved. However, people were not always safe from avoidable harm and neglect and solutions to risks were not always collaborative.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

2 service users living with advanced dementia were receiving the regulated activity. Feedback from staff and a relative helped us learn about their experiences. The relative we spoke with told us “I haven’t had to make any complaints about [their] care. Generally, [they] are always well turned out and I have no concerns.” Staff we spoke with told us managers and senior staff “Never spoke to me inappropriately” and “They call you by your name and you can call them by their name, no blame culture.” We found staff had a positive experience of being able to speak up about issues and concerns.

Managers told us all staff were aware of what was safe and what was unsafe for people living at the service. Any incidents where people were put at risk were investigated and meetings held with the staff to ensure lessons were learnt. Managers told us they understood their responsibilities under the Duty of Candour, to report to families when things go wrong. Staff confirmed they received effective training. Learning was taken from incidents and action were taken to address and reduce re-occurrences. Managers encouraged an open, transparent, and reflective culture and provided staff with support after incidents and near misses. Managers provided people using the service, their representatives, and staff with various options to be able to raise concerns without fear about what might happen.

The provider learnt lessons when things went wrong. They had policies and procedures which included how to achieve continuous improvement and provided ‘on the spot’ refresher training for staff on topics such as the Mental Capacity Act. Managers continually reviewed all incidents and accidents, safeguarding concerns, complaints and near misses to determine potential causes and identify any actions they needed to take to reduce the likelihood of reoccurrence and learn lessons. This information was shared and discussed with staff during team meetings. The provider had implemented a Key Worker system to ensure people had access to a named staff member they could speak to.

The provider had not notified CQC of a safeguarding issue in a timely manner, however, this was addressed during the assessment and the registered manager had agreed the incident should have been reported sooner. Feedback from external professionals during the assessment and inspection was generally positive. Queensbridge House worked well with a variety of professionals to ensure good health and well-being of the people living there, for example specialist teams have done training with the staff for people who have specific needs. The Registered Manager told us they had a good working relationship with external partners. The Registered Manager had implemented a pre-admission policy where people who wanted to come to live at the service would come over a period of several days or months and spend time in the environment before deciding to live there. Staff were also consulted in a team meeting prior to admission to determine their views on the new person’s needs and their ability to meet those needs. This helped to ensure the compatibility of people living at the service during transitions.

There were safe systems in place to ensure vital information was shared with the necessary external professionals. The providers electronic care planning system produced a summary of people’s key needs, requirements, and medicines. Respect forms were in place for people, this meant a safe transition between services, such as, admission to hospital.

A relative told us “I have no cause for concerns about [their] care.” Staff were able to raise concerns with the registered manager during the inspection and we found the manager was receptive and proactive in addressing the issues raised. Staff we spoke with told us about a concern they had regarding bruising on some people living at the service and they felt confident to approach the registered manager to confirm their understanding on appropriate techniques. This was a positive example of how a safeguarding concern was addressed openly and promoted staff understanding of good practice. We found staff and relatives were aware of safeguarding requirements.

Staff and the registered manager had a detailed understanding of local safeguarding procedures and told us who they would report concerns to both inside and outside their organisation. Staff commented on a recent safeguarding situation where they had recognised poor practices which led to people being unsafe. Staff told us about information sharing in handovers which lead to learning about when things went wrong. The registered manager acted swiftly to address concerns and put in processes to improve practices.

People were relaxed in the presence of staff. Staff took the time to meet people’s emotional needs. People seemed comfortable in the presence of staff, and staff were always present in communal areas. However, safeguarding information prompts and reporting guidance was not visible around the service, people were expected to speak to staff to report concerns.

There was person centred care documentation in place and competencies for staff were reviewed. The provider had processes for staff in place to prevent abuse which were detailed; however, staff had not always followed these processes. Systems designed to protect people from abuse had not always been effective. For example, there had been an incident on a night shift where not all staff were trained to deliver personal care. This had contributed to some people not receiving care in a timely manner. This resulted in neglect of people who were vulnerable. Action was taken immediately to address this and to ensure people were safeguarded from abuse.

Overall, relatives felt staff understood people’s needs well and supported them to safely manage risks. We received positive feedback from staff about their understanding of supporting people with dementia. Staff told us how there is a balanced and proportionate approach to risk, which supports people and respects the choices they make about their care.

Staff who delivered care were able to explain in detail how they supported people to manage risks. The information was recorded within people’s care records. However, on one occasion, we observed one person not receiving the support recorded in their care records. Although this had not put this person at risk, the reason for this was immediately investigated and addressed so any potential risk was mitigated. On the second day the inspection we observed this person receiving their planned care. On another occasion, during the first day of inspection staff were observed serving food to one person which was not in line with their specific dietary needs. This was addressed and rectified and was one person on one occasion. Staff we spoke with felt confident with seeking support from senior staff when required. There is a culture of wanting to support people with their risks in the least restrictive way and to work with people and professional teams to find out the best way to achieve this. The registered manager told us how professional support was sought when a person’s mobility needs changed, and they were deemed at risk of falls.

Staff supported people’s risk in line with the guidance within their individual care documentation. Staff had a good understanding of people’s needs. People were observed to have equipment they needed to keep safe. During the first day of the inspection, staff did not present food to one person who needed a special diet in line with their needs, although this did not have a direct impact on them, it was discussed with the manager and improvements were noted on the second day of inspection.

There was a culture of positive risk taking within the service which was supported by the provider’s processes and systems. This enabled a balanced and proportionate approach to risk which improved people’s quality of life. For example, the provider enabled flexibility to enable people to be supported with new activities and additional support where needed. The provider had sufficient processes and systems in place and people’s risk assessments were detailed and individualised. It was clear how the risks were specific to each individual including signs to be mindful of skin breakdown and the risk of developing pressure sores. The provider had worked with people to understand and manage risks by thinking holistically so care met their needs in a way which was safe and supportive and enabled people to do the things which mattered to them.

People and their relatives told us the environment was safe and people were cared for in safe environments which are designed to meet their needs.

Staff were aware of the arrangements within the team to ensure they considered and checked the environment. For example, staff explained to us how they regularly review the environment in relation to people with specific risks. There was enough equipment and staff were aware of how to request additional equipment if needed. The registered manager ensured health, safety and maintenance checks were regularly completed. Personal emergency evacuation plans and fire safety measures were in place. The fire risk assessments signposted staff to look at the evacuation plan for everyone. The provider had a business continuity plan which provided guidance on contingency plans in case of emergencies and untoward events which could affect the service. The provider had regular audits in place for different departments such as the laundry and kitchen as well as infection control audits and equipment audits and these had been regularly updated.

The environment was safe and well cared for. Care equipment was in good working order. There was no clutter, and the home was accessible for people with mobility needs. Improvements to safety were noted from the last inspection in the laundry room and window restrictors were in place on first floor windows.

One member of staff we spoke with told us “[the team] are friendly, welcoming and nurturing”. A relative told us “It seems like they are always doing training, getting people up to date on processes, and learning, for example, manual handling training”.

Staffing levels were observed to be adequate for the level of care required. Team leaders and senior staff had a good understanding of the need to ensure the staff allocation remained appropriate to people’s needs and to ensure there were the right staff numbers and skills in the right place. The registered manager told us there was a high ratio of staff to people living at the service on both day and night shifts. On the first day of our inspection there were new staff receiving their induction training, and the registered manager told us recruitment was on-going. The registered manager told us continuity of care was important and was a priority for the provider. Staff received training which helped them in their roles. The registered manager told us about a system they had in place called ‘touchdowns’ which occurred between the registered manager and staff during the first few weeks. The registered manager would meet with the new starters to see how they were progressing. The registered manager told us “We get them in, we talk about how they're feeling, if they're having any problems or difficulties.” The registered manager explained all staff needed to complete specific training which related to the unique needs of the people living at the service before they were permitted to work independently or escort people outside of the service.

Staff were attentive to people’s needs and no one needed to wait for support. Staff made sure a team member was always in the lounge with people. They chatted with people and offered support where appropriate. Everyone who needed support was attended to in a timely manner. Staff were observed attending an induction training session.

Staffing levels were monitored by the managers and there were clear systems in place to ensure safe staffing in the event of any emergencies. Staff training was reviewed and addressed additional training needs in relation to people’s needs and risks. Staff were mostly up to date with training, and sessions which had not been completed were booked in the future for staff. Where staff had not completed mandatory online training, the manager told us about the support offered to people who had English as a second language. There were clear refresher dates and upcoming training expiry dates showed in the training matrix. Staff were supported to complete competency checks, for example for safeguarding and specific diagnosis of individuals living at the service. The deputy manager had recently introduced ‘Breathers’ which a process whereby every two or three months, staff are given one on one time with the deputy manager to discuss work or any issues they may be having and how the management can help them. We looked at 3 recruitment files and found staff were recruited safely.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were given their medicines by staff as prescribed safely and in a timely manner. This was recorded on their medicines administration record (MAR) by the staff.

Guidance was available in the provider’s policies to help staff manage medicines safely and effectively. Staff were trained in medicines administration and had competency assessments completed. This ensured staff could handle medicines safely. Staff collaborated with clinical healthcare professionals during medicines reviews.

The medicines policies in place were past the stipulated review date. The staff did not always follow the provider’s policy and national guidance for the safe disposal of medicines. The staff did not always accurately monitor and record the temperature of the refrigerator used to store medicines which included insulin and prescribed eye drops. If medicines are not stored at the manufacturer's recommended temperature, they may not be effective. Medication administration records (MAR’s) were updated accurately and in a timely way when medicines were administrated, started, and changed. Handwritten MARs were checked by two members of staff to ensure they were accurate. Medicines were accurately recorded when people entered the service. People’s allergies were accurately recorded. Regular medicines audits were carried out to identify gaps and make improvements. However, the audits we saw indicated the medicine refrigerator temperature checks were compliant with the provider's policy, but the evidence we collected did not support the audit’s findings. This meant the audits were not robust enough to identify concerns and put people’s medicines at risk of being ineffective.