This was an unannounced inspection that took place on 13, 14 and 16 February 2018.

Queens Court 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. Queens Court provides care for up to 43 people including people with dementia and is located in the Wimbledon area of west London.

The home 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 and associated Regulations about how the service is run.

At the last inspection in January 2016 the overall rating was good.

At this inspection the overall rating was good.

The people and their relatives that we spoke with said the care and support provided was good and delivered in a friendly atmosphere. There were enough staff available to meet people’s needs and they did so in a skilful, friendly and kind way.

The home’s records were thorough, comprehensive and up to date with regularly reviewed information recorded in a clear and easy to understand way.

People and their relatives were encouraged to discuss health needs and they had access to community based health professionals as well as nursing and care staff. People had balanced diets that also met their likes, dislikes and preferences and protected them from nutrition and hydration associated risks. People and their relatives told us the meals provided were of excellent quality and plenty of choice was provided. Staff prompted people to eat their meals and drink as required whilst enabling them to eat at their own pace and enjoy their meals.

The home was clean, well-furnished and maintained and provided a safe environment for people to live and staff to work in.

Staff were knowledgeable about the people they supported and had the appropriate skills and training to meet people’s needs competently. They focussed on providing people with individualised care and support and this was provided in a professional, friendly and supportive manner.

Staff were aware of their responsibility to treat people equally and respect their diversity and human rights. They treated everyone equally and fairly whilst recognizing and respecting people’s differences.

Staff thought the registered manager and organisation provided good support and there were opportunities for career advancement.

People and their relatives said the registered manager and staff were approachable, responsive and encouraged feedback from people.

The home had systems that consistently monitored and assessed the quality of the service provided.

The Mental Capacity Act and DoLS required the provider to submit applications to a ‘Supervisory body’ for authority. Applications had been submitted by the provider and applications under DoLS had been authorised, and the provider was complying with the conditions applied to the authorisation.

The inspection took place on 19 January 2016 and was unannounced. The last inspection of this service was on 23 October 2013. At that inspection we found the service was meeting all the regulations we assessed.

Queens Court provides accommodation for up to 43 people who require nursing, personal care and support on a daily basis. The home specialises in caring for older people with dementia. It is also able to provide end of life care. At the time of our inspection there were 36 people living at Queens Court.

The service has a registered manager in post. 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 working at Queens Court had a comprehensive induction programme and training to equip them to undertake their roles and responsibilities. The training was supported by the home’s trainer who ensured regular refresher courses and access to external courses. The home had good links with local universities for research and the placement of students.

We saw staff were knowledgeable about people and understood how to meet their diverse needs. We observed a genuine warmth and affection between most staff and people who used the service. People were generally treated with dignity and respect. We also observed a couple of occasions where people might not have been treated with dignity and respect. This was when staff were standing and helping people to eat and by the way one member of staff spoke about people using the service.

The feedback we received about staffing levels from people, relatives and staff was mixed. Some thought there were not enough staff and others through there were enough staff. Our findings on the day of the inspection showed there were enough staff to meet the needs of people living in the home. The registered manager told us they kept the issue of staffing levels under continuous review.

People had their health needs met. This included having access to healthcare professionals when they needed them. People’s nutritional needs were assessed and monitored. They received a variety of meals according to their choices and needs. People were extremely positive about the meals provided. People received their medicines as prescribed to them.

Care was individualised to meet people’s needs. There was a range of social activities for people to participate in if they chose. The home had good links with local schools and churches to maintain people’s involvement in the local community. Relatives were free to visit whenever they wished and were very positive about the service their relatives received.

The home was able to care appropriately for people who were nearing the end of their life, so people could remain in the home if they wished to.

People were safe living at Queens Court. Staff were knowledgeable about what they needed to do if they suspected anyone was at risk of abuse. The provider had taken steps to ensure only suitable staff were recruited to work at the home.

People were asked for their consent before care was provided. If people were not able to give consent, the provider worked within the framework of the Mental Capacity Act 2005. The Act aims to empower and protect people who may not be able to make decisions for themselves and to help ensure their rights are protected.

We received some mixed responses about the management of the service. The majority of people and staff felt supported by the registered manager. We received some feedback that some did not feel the registered manager was open and inclusive.

The service had a number of measures in place to monitor the quality of the service. There was a drive towards continuous improvement. There was a providers’ complaints policy and the home kept a log o

Queens Court provides accommodation for up to 43 people who require nursing, personal care and support on a daily basis. The home specialises in caring for older people with dementia. When we visited, 40 people were living in the home.

People told us they were very happy with the care and support they received. They told us they enjoyed the food in the home and the activities provided. In particular, a number of people commented they enjoyed regular trips out of the home. They also told us care staff were “very kind” and “knew what they’re doing”.

People received the support they needed at lunch time and they were encouraged to make choices about what they ate and drank.

The care staff we spoke with demonstrated a good knowledge of people’s care needs, significant people and events in their lives and their daily routines and preferences. They also understood the provider’s safeguarding procedures and could explain how they would protect people if they had any concerns.

The home’s registered manager had been in post for 13 years. She provided strong leadership and people using the service, their relatives, care staff and visiting professionals told us the manager promoted very high standards of care.

We found the provider to be meeting the requirements of the Deprivation of Liberty Safeguards.

We saw all communal parts of the home and some people’s bedrooms, with their permission. We saw the home was clean, hygienic and well maintained.

On the day of the inspection we spoke with nine people who used the service. Most of them spoke positively about it. One person told us “They look after me very well. You see they’ve just brought tea, and they came with water not long before.” Another person said “The staff are very kind and helpful. I can’t fault them.” A third person told us “the staff are so kind and helpful. They can’t do enough for you.” We also spoke with three family members, and one visitor at the service. They were also positive about the service. One of them told us “They show real concern and care for my relative as an individual.” We saw that people were asked for their consent before care was provided.

Some people at the service were not able to communicate their views and so we observed the care offered. We saw that staff spoke respectfully to people at the service and appeared to know people well. There were a variety of activities offered to help stimulate people. There were detailed plans of people’s care and we saw from records that the service worked effectively with a range of health professionals. We spoke with one professional who said that they had no concerns at all about the care provided.

We saw that the service was clean and there were efficient systems in place to minimise the risk of infection control. There were robust systems in place to monitor the safety and effectiveness of equipment. Recruitment procedures followed up to date guidance. There was a visible complaints procedure and we saw that people’s views about their care were also sought through regular residents and relatives meetings.

Not all of the people living at Queens Court were able to share their views and experiences during our inspection, due to their complex needs. We were able to speak to some people using the service, visiting relatives and a General Practitioner (GP) who were all positive about the care they had experienced or seen. People told us they were treated with kindness and respect by staff. They said they were supported and encouraged to undertake the activities they wanted to do including those outside of the home. They also told us they were given choices especially around the meals that they ate.

We observed from people’s records, their individual care, treatment and support needs had been assessed and care plans were in place to meet these needs. We saw people using the service were asked for their views and preferences about how they wanted to be looked after. Staff had received regular training to keep their skills and knowledge refreshed and up to date. They are aware about what they should do to protect people who may be at risk of abuse, harm or neglect. We saw senior staff regularly reviewed and assessed the quality of service provided. We also saw people using the service and their representatives were asked for their views about the quality of service provided.