This inspection was carried out on 16, 21 and 29 August 2018. The first and third days of the inspection were unannounced. The Priory Nursing and Residential Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.
The home provides accommodation and support with nursing and personal care to a maximum of 37 people. The home provides a service to older people and younger adults. Accommodation is arranged over two floors with a shaft lift giving access to the first floor.
Our last inspection of the service took place in March 2018 where the overall rating was good.
This inspection was prompted by concerns shared with us by the local authority safeguarding team and the clinical commission group (CCG).
At the time of our inspection there was a registered manager in post however they had been on extended leave since July 2018. We have since received an application from the registered manager to cancel their registration with us. 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.
Risks were not always identified and there were no systems in place to mitigate risks to the health, safety and well-being of the people who lived at the home. People’s medicines were not managed or stored in a safe way. People were not fully protected from the risk of harm or abuse. People were not protected by the provider’s procedures for the prevention and control of infection. Environmental risks were not well managed or addressed in a timely manner. There were no systems in place to monitor accidents or make improvements when things went wrong. There were sufficient numbers of staff to meet people’s physical needs. The provider’s staff recruitment procedures helped to ensure staff were suitable to work with the people who lived at the home.
The provider’s systems did not ensure staff had the skills, training, knowledge or experience to meet the needs of the people who lived at the home. People’s rights were not respected. People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible. No reasonable adjustments had been made to support people who had a visual or hearing impairment. There were no effective procedures in place to monitor and meet people’s healthcare needs. People were not supported to eat well in accordance with their tastes and preferences. There was a lack of signage to assist people to orientate themselves around the home. An assessment of people’s needs was carried out before they moved to the home.
Staff were kind to the people who lived at the home however people’s dignity was not always respected. Staff did not have time to spend quality time with people. Staff did not have information about people’s social history or interests. People’s records were not securely stored and people’s confidentiality was not always respected.
People were not supported to be involved in the planning or review of the care they received. Care plans had not always been updated to reflect changes in the support people received. People had limited opportunities for social stimulation. People could not be confident that any complaints about the care and treatment they received would be responded to. Information about how to raise concerns had not been produced in an accessible format for people who had a visual or cognitive impairment. People could not be confident that their wishes during their final days and following death were respected.
Ineffective leadership in the home had impacted on the people who lived at the home and the staff team. The provider's quality assurance systems had failed to identify the significant concerns in the service and had been ineffective in driving improvements. The ethos of honesty, learning from mistakes and admitting when things had gone wrong was lacking. The provider had not met their legal responsibilities to inform the Care Quality Commission of significant events which had occurred in the home.
The overall rating for this service is 'Inadequate' and the service is therefore in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.