Priory Care Residential Home

We found the following examples of good practice.

The home was clean and tidy. Staff used appropriate cleaning products and regularly cleaned all areas of the home to help reduce the risk of infection. The provider had invested in maintaining the building and furniture was in good condition and easy to clean.

Safe visiting processes were in place. Visitor protocols were in place to ensure anyone entering the service received a lateral flow coronavirus test, was temperature tested and provided with personal protective equipment (PPE) to remain safe during their visit. The provider had invested in PPE training for visiting family and friends to ensure PPE was used safely when indoor visits commenced.

People were supported to maintain important relationships with their families and friends. This included phone and video calls and window visits. The provider had discussed visits with people and their families to ensure appropriate contact was maintained.

Social distancing was maintained, and people were admitted to the service safely. Isolation processes were implemented for people new to the service and if people displayed symptoms of COVID-19 or received a positive test result. Staff and people using the service were regularly tested for COVID-19.

Staff were trained in the use of PPE and used it appropriately. The provider regularly completed ‘spot checks’ to ensure staff had the relevant skills and knowledge for hand washing and PPE use.

At the last inspection in July 2016 we were concerned that care and treatment was not person-centred. We issued a requirement in respect of Regulation 9 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that people’s care plans had been updated and that people received care that was based on their individual needs. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that staff did not act in accordance with the Mental Capacity Act 2005 (MCA) in respect of consent and making informed decisions. We issued a requirement in respect of Regulation 11 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that people’s records had been updated to reflect their capacity to make decisions and consent to aspects of their care. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that medicines were not being managed appropriately and that the emergency call bell had not been properly maintained. We issued a requirement in respect of Regulation 12 (1) (2) (d) (e) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that the management of medicines was safe and that a new emergency call bell system had been installed. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that there was a lack of maintenance certificates and risk assessments in place and that a high standard of hygiene was not being maintained. We issued a requirement in respect of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that equipment was well maintained and that the premises were maintained in a clean and hygienic condition. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that the provider had failed to maintain an accurate, complete and contemporaneous record in respect of each person who lived at the home. We issued a requirement in respect of Regulation 17 (1) (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we saw that people’s records were complete and accurate. The provider was no longer in breach of this regulation.

At the last inspection in July 2016 we were concerned that CQC had not been notified about DoLS applications that had been authorised as required by regulation. This was a breach of Regulation 18 of the Registration Regulations 2009. At this inspection we saw that notifications about DoLS and other issues had been submitted to CQC, meaning the provider was no longer in breach of this regulation.

At this inspection we found there was a manager in post and they had been in post since the home was first registered. People who lived at the home, relatives and staff reported that the service was well managed.

Staff had been recruited following robust policies and procedures and people told us they felt safe living at the home. Sufficient numbers of staff were employed to make sure people received the support they needed.

People told us they were happy with the choice of meals provided at the home. People’s nutritional needs had been assessed, people’s special diets were catered for and food and fluid intake was being monitored when this was an area of concern.

Staff were kind, caring and patient. They encouraged people to be as independent as possible and respected their privacy and dignity.

An activities coordinator had been employed and people told us they were happy with the activities on offer.

Risks to people were assessed and reduced where possible. Staff received training on safeguarding adults from abuse. They were able to describe different types of abuse they may become aware of and the action they would take to protect people from harm.

People understood how to express any concerns or complaints and were encouraged to feedback their views of the service provided. We received positive feedback from everyone who we spoke with.

Staff told us they were well supported through supervision and staff meetings.

Quality assurance systems were robust and where they identified shortfalls in the service, actions had been implemented.

Priory Care Residential Home is registered to provide accommodation and personal care to up to 25 people. The service supports older people, some of whom may be living with dementia and people with a physical or sensory impairment. The service is located in Cottingham, in the East Riding of Yorkshire and close to the city of Hull. At the time of this inspection there were 20 people using the service.

The registered provider is required to have a registered manager and the manager in post was registered with the Care Quality Commission (CQC) in September 2015. 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.

There was a lack of maintenance certificates and risk assessments in place, which meant the registered provider could not assure us that the premises and equipment used by the service was properly maintained. There was on-going building work within the service, but some areas of the premises were not clean, well maintained and did not maintain standards of hygiene appropriate for the purpose for which they were being used. There was a major refurbishment of the service taking place. The majority of the people and relatives we spoke with said they were confident that things in the service were improving. Staff were optimistic about the future of the home and felt the registered manager would drive forward the necessary improvements needed to ensure the service met people's needs.

The recording, administration and return of medicines was not being managed appropriately in the service. People said they received their medicines on time and when they needed them, but we found that staff practices for medicine management were not robust.

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home. However, the dining experience of people living with dementia could be improved as there were no picture menus and the lack of visual prompts meant they found it more difficult to make a choice about what they wished to eat each day. We have made a recommendation in the report about this.

The care and treatment of people using the service did not always meet their needs. People told us that they were often bored and lacked stimulating and interesting social opportunities to keep them engaged and occupied.

People spoken with said staff were caring and they were happy with the care they received. We saw appropriate moving and handling techniques used to assist people with their mobility and people were satisfied that their privacy and dignity was maintained at all times. However, we found that there was little documentation about the support of people receiving end of life care. We have made a recommendation in the report about this.

The registered provider failed to notify the CQC about Deprivation of Liberty Safeguard applications which had been authorised by the supervisory body. They had also failed to ensure that where a person lacked mental capacity to make an informed decision, or give consent, that staff acted in accordance with the requirements of the Mental Capacity Act 2005 and the associated code of practice.

There were processes in place to help make sure the people who used the service were protected from the risk of abuse and the staff demonstrated a good understanding of safeguarding vulnerable adults procedures.

Quality assurance and record keeping within the service needed to improve. There was a lack of auditing within the service. We saw evidence that care plans, risk assessments, food / fluid charts, turn charts and end of life plans were not always accurate or up to date. This meant that staff did not have access to complete and contemporaneous records in respect of each person using the service, which potentially put people at risk of harm.

Improvements were needed to the number of staff on duty to meet the needs of people who used the service. People and staff commented that the levels of staff on duty fluctuated on a daily basis and this was also evidenced in the staff rotas. We have made a recommendation in the report about this.

The recruitment files of new and existing staff members did not always contain the necessary employment safety checks required to ensure staff were fit to work with vulnerable adults. The registered manager was updating the files at the time of our inspection. We have made a recommendation in the report about this.

Staff told us that they felt supported by the registered manager, but we found no evidence of supervision records and some staff said they had not received formal supervision. We have made a recommendation in the report about this.

There was a complaints form on display in the entrance hall but no evidence of a policy and procedure for people to view. We have made a recommendation in the report about this.

During our inspection we found breaches of regulation in relation to premises and equipment, safe care and treatment, person centred care, need for consent, good governance and notice of incidents. You can see what action we told the registered provider to take at the back of the full version of this report.