Archived: Priory Park Care Home

Updated 10 December 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

This inspection was carried out by two inspectors on the first two days and an expert by experience, one inspector and a pharmacy inspector on day three. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

Priory Park Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates up to 40 people.

The manager was registered with Care Quality Commission. This meant they and the provider were legally responsible for how the service was run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was unannounced.

What we did before inspection:

Before the inspection, we reviewed all the information we held about the service such as notifications. These are events that happen in the service the provider is required to tell us about. We also sought information from the local authority’s contract monitoring team and safeguarding team. We used our planning tool to collate and analyse the information before we inspected.

We did not ask the provider to complete a Provider Information Return (PIR) in advance of this inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection:

During the inspection, we spoke with five people who lived in the home, three relatives, six members of staff, the administrator, the maintenance person, the registered manager, the deputy manager. We also discussed our findings with the acting regional director and the regional manager. We looked at the care records of 10 people who lived at the home, looked around the premises and observed staff interaction with people. We also examined a sample of records in relation to the management of the home such as staff files, medicines administration records, quality assurance checks, staff training records and accidents and incidents. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

After the inspection:

We continued to seek clarification from the provider to validate evidence found and seek assurance that urgent action had been taken to address the significant concerns we found. We looked at training data and quality assurance records. We had a meeting with the local authority and the clinical commissioning group regarding the concerns we identified during the inspection and spoke to several professionals who regularly visited the home.

Updated 10 December 2019

About the service:

Priory Park Care Home is a nursing home registered to provide accommodation and personal care for 40 people with either nursing or residential care needs. Care is provided between two floors with people living with dementia on the second floor and people requiring residential and general nursing care on the first floor. At the time of the inspection, 34 people lived at the home.

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

People told us they felt safe and staff were kind and caring. However, our observations showed that people did not always receive safe care and treatment. Practices in the home did not always demonstrate that staff understood how to safeguard people from neglect and abuse. People’s safety had been compromised due to lack of adequate numbers of staff to support them with their care needs. We found a significant number of incidents of people being left unsupervised and causing harm to each other. Risks to receiving care were poorly managed and planned for. People were not always offered their medicines in a safe manner and medicines administration practice exposed them to risks.

People were not always monitored following a fall or incident. The provider had not adequately analysed accident and incidents to identify themes and trends and reduce re-occurrences. There were no lessons learnt processes to show how staff had learnt from events. This led to a repeat of incidents that exposed people to risk. The registered manager and staff had not always followed safeguarding protocols to ensure all reportable concerns were reported to the local authority.

People were not always supported by staff who had received induction, supervision or had the right skills and competence to carry out their role safely. People were not always supported to have maximum choice and control of their lives. Staff had not always sought consent before delivering care. People’s ability to make their own decisions was not always assessed. People received support to maintain good nutrition and hydration, however they were not effectively monitored for deterioration or changes in their needs.

Our observations during the inspection, were of positive and warm interactions between staff and people who lived in the home. However, we also found evidence which showed people were not always treated with dignity and respect because their needs were not always responded to appropriately. Some people told us staff treated them with dignity and were respectful. However, two people felt this was not always the case with some of the staff. People’s dignity had been affected by the shortages of staff. Staff promoted people’s independence, but this lacked consistency.

People’s care records contained personalised information on their health and communication needs plus their likes and dislikes. We found care records were not always up to date and did not provide staff with adequate guidance on how to support people and reduce risks around them. People and family members knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly. Previous complaints had been investigated however outcomes had not always been used to improve care delivery.

There had been a rapid decline in the quality of the care at the home due to lack of leadership and oversight. Staff had not been given adequate leadership and oversight which led to poor care delivery. There had been instances when people had suffered injuries and deterioration of their conditions. Staff had not always recognised a deterioration in people's conditions and provide them with the right clinical support. The system did not proactively monitor areas where the care delivered was not safe or meeting standards.

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 24 October 2018) and there was a breach of regulation in relation to medicines management. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found further deterioration in medicines management, no improvements had been made and the provider was in continued breach of the regulation.

Why we inspected:

This was a planned inspection based on the previous rating.

Enforcement:

We have identified multiple breaches in relation to the arrangements for keeping people safe from harm, the management of medicines , seeking consent and staffing levels. We also found breaches in relation to dignity and respect, record keeping, staff training and supervision, failure to submit notifications and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up:

We will meet with the provider to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.