Archived: Priory Radstock

Priory Radstock is a care home providing accommodation and personal care for up to 12 people with learning disabilities, autistic spectrum disorder and/or mental health needs. The home comprises of the main house which contains five self-contained flats and five en-suite bedrooms. Alongside the main house there is another house called, The Coach House. At the time of the inspection there was one person living in the Coach House and 10 people living in the main house.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 12 people. Ten people were using the service. This is larger than current best practice guidance. However. the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people.

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

Staff had not received a full range of comprehensive training to enable them to fully understand and support people’s needs. The registered manager had a plan in place to address this.

There were systems in place to monitor the standard of care provided at the service. The systems were not fully effective in identify all of the areas for improvement we identified during the inspection.

Staff received regular one to one supervision and told us they felt supported.

Most areas of the home were clean; however, the laundry room was not. The registered manager took immediate action to rectify this.

People told us they felt safe living at Priory Radstock. Staff felt confident to raise concerns with the registered manager and were aware of external agencies where they could report concerns.

Staff supported people to manage their medicines safety. Risks to people were identified and guidance was in place for staff to reduce the level of risk to people.

There were enough staff available to support people. Staff were recruited safely.

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’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals to meet people’s needs.

People were supported by caring staff who worked towards promoting their dignity and independence.

People’s care plans were detailed, people and their relatives were involved in writing their plans. Some of the care plans we viewed contained inaccurate information, and daily notes were not always fully completed. Some additional information was required in some care plans to ensure they provided staff with information in line with national guidance.

People's concerns and complaints were listened to and responded to. People and staff commented positively about the management of the service.

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

Rating at last inspection

The last rating for this service was good (May 2017).

Why we inspected

We brought this inspection forward because of concerns we had identified in one of the providers other locations.

Rookery House provides accommodation for people with learning disabilities and/or mental health needs. Seven people lived in the main house, three of whom had their own flats in the main house. Alongside Rookery House there was another house where people lived independently, called The Coach House. At the time of our inspection, three people lived in The Coach House.

There is 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.

One person living there told us they did their own cooking and worked towards living independently. They showed us their room, and told us how much they liked it. People living in The Coach House were able to join in with activities in the main house if they wished.

Relatives told us people were kept safe and free from harm. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People were supported to be as independent as possible with meals and drinks. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff knew the people they supported and provided a personalised service. Care plans were in place, detailing how people wished to be supported and families were involved in making decisions about their care.

There were suitable recruitment procedures and required employment checks were undertaken before staff began to work at the home. Staffing levels and skill mix were planned, implemented and reviewed to keep people safe at all times. Any staff shortages were responded to quickly and appropriately.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring if there are any restrictions to their freedom and liberty, these have been lawfully authorised by the local authority as being required to protect the person from harm.

Assessments were undertaken to assess any risks to the person and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments we read included information about action to be taken to minimise the chance of harm occurring.

Systems, processes and standard operating procedures around medicines were reliable and appropriate to keep people safe. Monitoring the safety of these systems was robust.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the registered manager and provided feedback on the service.

The registered manager and provider undertook spot checks to review the quality of the service provided and made the necessary improvements to the service where the need was identified.

There was a registered manager for the service. 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.

People and staff were potentially unsafe and faced risks on a regular basis. Action was not always taken where there were risks identified to the safety and wellbeing of people. Incidents included people being aggressive, people appearing to be under the influence of drugs or alcohol, people throwing furniture, self-harming and staff finding people unrousable.

A senior manager and the registered manager carried out quality checks on the overall quality of

care and service people received. However, the checks had not fully identified and put in place actions that may be needed to keep people safe. This was in relation to the high number of occurrences and incidents that we found had been happening.

People were positive in their views of the staff and the support given by staff with their particular range of needs. People were treated in a kind and caring way and staff spent plenty of time with them. We saw plenty of positive and warm interactions between them and people looked relaxed with the staff.

People had access to health professionals to support them with their physical health needs. Care plans explained what actions were required to meet people’s range of care needs. Care records included life histories about each person. This helped staff to know each person and to provide them with personalised care.

The staff team were provided with training and support to do their jobs effectively. This gave staff the knowledge and skills to meet people’s needs.

People knew how to make complaints about the service and there was a complaints procedure in place that ensured concerns and complaints were properly addressed.

People were supported by staff to make decisions in their daily lives. Staff knew about The Mental Capacity Act 2005. The service worked with people, relatives and social care professionals when needed to assess people’s capacity to make specific decisions. Staff understood the importance of seeking consent before providing people with all aspects of care.

People were supported to have enough to eat and drink at times of their choosing. People were encouraged and assisted to prepare and cook meals for themselves.

People were supported to pursue activities and interests that they enjoyed both within and outside of the home. Individual interests and preferences were encouraged and plans of support and care were specific to people’s individual needs.

The staff team were clear about the aims and values of the home and put these into practice.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

People told us the home was a safe place for them to live. One person said 'It's safe here. Each person has a keyworker so if you had any problems you would normally go to them first.'

Care was planned and delivered in a way that ensured people's safety and welfare. Care plans included a range of individual risk assessments and agreed actions for managing these risks.

People told us that staff treated them well. People were cared for by staff who were aware of the risks to people's safety and health and staff knew how to support them in a safe way.

Recruitment practice was safe and thorough. People were cared for by suitable staff.

Systems were in place to make sure that staff learned from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. While no one was currently deprived of their liberty, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

People told us that they were happy with the care they received and that their care needs were met. It was clear from observations and from speaking with staff that they had a good understanding of people's care and support needs. One person told us 'The staff are really helpful and understanding. They take time to explain things to me.'

People's health and care needs were assessed with them, and they were involved in developing and reviewing their plans of care.

Staff recorded information about each person on a daily basis. Information included how people had spent their day and how they had responded to therapies or activities. This meant the effectiveness of people's care plans could be fully reviewed.

There was an independent advocacy service available if people needed it. This meant that when required people could access additional support.

Is the service caring?

People were supported by skilled and attentive staff. We saw that staff knew people very well, showed patience and gave encouragement. One person told us 'The staff are friendly. People seem quite happy here and do quite well.'

People who lived in the home, their relatives and staff were encouraged to share their views of the service. Where shortfalls or concerns were raised these were addressed.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People's needs were reviewed regularly and in response to any changing needs. We read information in people's records which indicated they had been consulted about the care they received.

People's preferences were gathered and used to plan care to meet their specific needs.

People had access to a wide range of activities and were supported to maintain relationships with people who were important to them.

The service worked well with health and social care professionals and services to make sure people received their care in a joined up way.

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

Is the service well-led?

The home was run by an experienced registered manager. They were supported by a deputy manager, administration staff and senior staff who were always available to support less experienced staff. The home also employed clinical staff to help plan, monitor and review people's care.

The service had an effective quality assurance system; records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving.

Staff told us they were clear about their roles and responsibilities. Staff had a very good understanding of the ethos of the home and quality assurance processes which were in place.

People who lived in the home, their relatives and staff members were asked for their views about the care provided and they were acted on. This helped to ensure that people received a good quality service at all times.

We found procedures were in place to minimise any risks to people who lived at the home. Regular audits had been carried out which monitored the on-going health and safety of people. Internal audits included health and safety checks (such as the cleanliness or safety of the environment and equipment) and a check on records (such as people's care plans and risk assessments).

They confirmed they were well cared for. They were supported by a range of health care professionals. One person said "I like it here. There are good staff here who look after me. They have helped me a lot.' Another person told us 'There are always staff around. They are really good.'

People told us they felt safe living in the home. They knew who to speak to if they were worried or upset. One person said "Yes, I feel safe living here." People were well supported if they presented difficult or aggressive behaviour.

They said that staff helped them with their medicines and that medicines were reviewed regularly or changed if people wished. Appropriate arrangements were in place in relation to obtaining, storing and giving medicines.

The provider had various systems in place designed to monitor the quality of the service provided to people and to ensure people were safe. These were used effectively.