The Priory Care Home

The Priory Care Home is a small residential home for up to 24 older people. People have their own rooms and use of communal areas such as lounges and a dining room. Accommodation is provided over two floors accessed by stairs and a lift. Some of the rooms available are self-contained flats for people to maintain independence. There are gardens which are accessed from the ground floor and available for everyone to use.

People’s experience of using this service and what we found

People were cared for by staff who had been recruited safely and had been trained in a range of topics. There were enough staff available to support people and the registered manager kept staffing numbers under review. Staff told us they felt supported and listened to by the management team.

People’s risks had been identified and there were plans in place to give staff guidance on the support to provide. People’s health needs were met as staff made timely referrals to healthcare professionals. People had their medicines as prescribed.

The home was clean and smelt fresh. Staff used cleaning schedules to record that all areas of the home were regularly cleaned. The provider made sure equipment and the premises were serviced and in good repair.

People were able to receive visitors indoors and outdoors. Systems were in place to make sure visiting was carried out safely. For example, visiting was pre-planned and booked in advance, visitors wore personal protective equipment (PPE) and had a Lateral Flow Test (LFT) prior to their visit. These precautions applied to all visitors including visiting professionals.

People and staff were regularly being tested for COVID-19 as per the government guidelines. Staff wore PPE and had been given training on how to use it safely. The provider had ample stock of PPE available at the home. Staff had received training on infection prevention and control good practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives told us the service was safe and felt homely and staff were friendly and welcoming. People told us they enjoyed the food and had a choice of meals, drinks and snacks. People had their own rooms which they could personalise if they wished.

There was a registered manager in post who had worked at the service for a number of years. People, relatives and staff told us the service was well-managed and they felt able to approach the registered manager with any concerns. The provider had kept people and relatives up to date with changes and events with weekly emails. Quality monitoring was being carried out to assess and identify any area for improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 October 2019) where we found three breaches of regulations. We imposed a condition on the providers registration for them to submit a monthly action plan to CQC. This recorded what action the provider took to make the required improvement and by when. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 13 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staff support and training and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Priory Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People were not supported to always manage their medicines safely. Risks had not always been identified or where identified there were not safe systems in place.

People were supported by staff who had been recruited safely. Once staff commenced work, the provider could not demonstrate they had provided new staff with a thorough induction. Staff were not always supported to develop their knowledge and skills. Opportunity to have a supervision meeting was not always made available.

People were supported by sufficient staff however, numbers of staff reduced at weekends. This meant that care staff had to take on additional duties on a weekend such as cleaning and meal preparation. We have made one recommendation about the calculation of staffing levels.

People had access to healthcare professionals and were supported to eat a healthy diet. People told us the food was a good quality. Feedback we received from professionals was complimentary about the care provided. Comments included, "I have found the staff to be extremely welcoming and helpful" and "[Registered manager] was always happy to discuss patients and I felt she knew the patients well, she always seemed to have their best interests at heart."

People had their own care plan, which was updated when needed. People had a formal review of their care with the registered manager and relatives where appropriate.

Quality monitoring systems, such as audits were not always effective. The systems had not identified the shortfalls we had found and there was no over-arching improvement plan for the service.

People told us the staff were kind, caring and knew them and what support they needed. People were involved in planning their own care and had the opportunity to share their views.

People were supported to maintain relationships, there was no restriction on visitors. People were able to join in planned activities and follow their own interests.

Where a complaint had been received it was managed and recorded. People and their relatives told us they thought the service was well-led. People and their relatives knew who the registered manager was and thought they were approachable.

Rating at last inspection: At our last inspection in January 2018 (report published in May 2018) we rated the service as Requires Improvement. We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is the second time this service has been rated Requires Improvement.

Why we inspected: This was a planned inspection based on the concerns we found at the last inspection and the service overall rating.

Enforcement: We have found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to the more serious concerns found during inspection is added to reports after any representations and appeals have been concluded. We will meet with the provider to discuss our findings in this report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection schedule. If any information of concern is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At the last inspection on 26 April and 4 May 2016, the service was rated as ‘Good’. At this inspection, we found the service had deteriorated to ‘Requires Improvement’.

A registered manager was employed by the service and was present during 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.

Why the service is rated as ‘Requires Improvement’:

Not all risks to people’s safety had been properly identified or addressed. This particularly applied to excessively high water temperatures, which increased the risk of people sustaining a scald type injury. Each accident and incident had been individually reviewed and a summary of occurrences had been completed. However, the information did not show an overview, to enable potential trends to be identified.

People’s medicines were not always safely managed. Whilst people had capacity to ask for their medicines to be taken "as required", information was insufficiently detailed to ensure they were administered as prescribed. Staff had received training in the safe administration of medicines and assessments of their competency were in the process of being undertaken.

There were some aspects which did not promote good infection control. This included brown debris on a hand wash basin and used paper towels overflowing from a bin in a communal toilet. Other areas of the home, including those less visible were clean.

People were encouraged to make decisions about their day to day lives but not all were undertaken in line with the Mental Capacity Act 2005. Documentation did not always show people had consented to equipment such as monitors and bedrails or that they were the least restrictive option available.

Systems to assess the quality and safety of the service were not always effective, as shortfalls found at this inspection had not been identified.

There were enough staff to support people effectively. Staff answered call bells quickly and had time to spend with people without rushing.

Staff were aware of their responsibilities to report any suspicion or allegation of abuse. Safe recruitment practice was undertaken to ensure staff were suitable to work with people.

People had sufficient to eat and drink and enjoyed a variety of well cooked, homemade food.

Staff were well supported and undertook a range of training to help them to do their job effectively. They knew people well and were responsive to their needs.

Staff supported people in a caring and respectful manner and promoted their rights to privacy, dignity and independence. People knew how to make a complaint and were encouraged to give their views about the service they received.

People were happy with their care and there was a strong focus on going out within the community. People enjoyed a varied social activity programme.

We recommended that continued improvements were made to people’s care plans to ensure all information was sufficiently detailed. We also recommended that improvements were made to demonstrate all decision making was undertaken in line with the Mental Capacity Act 2005.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of this report.

The Priory Care Home provides accommodation and care for up to 24 older people. There was 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. The registered manager was present throughout the inspection.

Staff knew people well and were knowledgeable about their needs. However, care plans did not reflect this knowledge and did not clearly show people’s needs and the support they required. The registered manager had identified this was an area, in need of improvement. As a result, they were implementing a new care planning format, which was expected to be clearer and more person centred.

The registered manager confirmed staff were competent in their role but had not undertaken up to date training in all areas of their work. A new training provider, which met the needs of staff and the home, had been sourced. Training courses were being arranged and staff training and development plans were in the process of being developed.

Staff said they felt valued and were well supported by each other and management. Staff received informal support on a day to day basis and met with the registered manager more formally to discuss their work. Staff worked well as a team. They said systems such as informal discussion, regular handovers and staff meetings, ensured good communication between each other and with management. Staff were aware of their responsibilities to report a suspicion or allegation of abuse and any poor practice they noted. However, the appraisal system to review staff’s strengths, weaknesses and further development was not taking place, as detailed within the home’s policy.

People’s medicines were safely managed although records did not show topical creams were always applied. People were able to tell staff when they needed their “as required” medicines but protocols for these medicines were not in place. All medicines were stored securely and administered in a person centred way.

Systems were in place to monitor the quality of the service. However, these were being developed to ensure all areas of the home were addressed. Accidents and incidents were effectively analysed to identify potential trends and minimise further occurrences. A daily walk around of the environment took place and staff were encouraged to identify and report any potential issues.

People and their relatives were happy with the service they received. There were many positive comments about staff, the overall care provided and the management of the home. People told us they felt safe and were able to follow their preferred routines, without restrictions. They said there was an emphasis on social activity and community involvement, which they enjoyed. People told us they enjoyed the food provided and had enough to eat and drink. People were offered a range of meal choices and snacks, based on their preferences.

People and their relatives were encouraged to give their views about the day to day management of the home. This was through informal discussions, “resident” meetings or the completion of formal surveys. People and their relatives knew how to make a complaint and were confident any issues would be appropriately addressed. They said there were always staff available and they received assistance quickly, when required. Staff and the registered manager confirmed sufficient staff were deployed to meet people’s needs effectively.

We found that people's consent was received before providing care and support. People's needs were assessed and care plans and risk assessments provided a person centred overview of how they wished to be supported. Where required people had access to a range of social and health care professionals to meet their needs.

The home was well maintained and kept in good condition. People told us their rooms were kept clean and they were happy with their accommodation. People enjoyed working in the garden and on the home's allotment.

The home was staffed by a settled staff team that knew the people well. Staff said there was always enough of them on duty to meet peoples needs. Staff received a range of training to enable them to meet peoples needs.

The home had a complaints procedure and people we spoke with said that they had not needed to make a complaint. They were confident their complaint would be addressed by the manager.