Primrose Bank Care Home

There are lounges and a dining room for people to enjoy. There is a garden area at the home and parking is available outside the home.

We found the following examples of good practice.

¿ The provider had ensured staff could access comprehensive and informative training in various aspects of infection control. This was delivered in different ways such as by demonstration and video information, to engage and support staff's understanding and practice. Staff confirmed they felt confident in the training and this helped them deliver care based on best practice.

¿ The environment had been arranged to minimise the risk of infection and was clean and clutter free. People told us they were consulted and happy with the arrangements in place to minimise the risk and spread of infection.

¿ Processes to minimise the risk of infection were carried out by staff. For example, temperature checks and increased cleaning of the home took place.

¿ Covid 19 policies and risk assessments were available.

¿ Checks, audits and analysis of information was carried out on the cleanliness of the home and action taken if this was needed.

¿ Adequate handwashing facilities, infection control gel and personal protective equipment (PPE) was available to support best practice.

¿ Staff supported people if they needed help to use electronic tablets and distanced visits were arranged whenever possible.

¿ People were supported to access health professional advice and care records were updated to reflect the advice. People told us they were well cared for and valued staff support.

¿ The service was taking part in the whole home testing process. People at the home were supported to decide if they wanted to participate. People were also supported to decide if they wanted to receive vaccinations for Covid-19. If people were unable to make this decision for themselves, best interest discussions were held with relatives and documented.

¿ Appropriate signage was displayed throughout the home to promote best practice.

Further information is in the detailed findings below.

Primrose Bank Care Home is a residential care home providing personal care for up to 44 older people. There were 39 people using the service at the time of the inspection. The service is provided from a large property close to the town centre, with communal areas and provides people with their own private bedrooms.

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

People received safe care and were protected against the risk of abuse and avoidable harm. Staff assessed and managed risks to people to help keep them safe. Staff managed people’s medicines safely and kept the home clean and hygienic.

People were cared for by staff who were well supported and had the right skills and knowledge to meet their needs effectively. Staff helped people with their healthcare needs and worked well with external healthcare professionals. The provider had done a significant amount of work to ensure they met people’s nutritional needs and worked with them to make sure food provision also reflected their preferences. 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 were treated well, with kindness and compassion by staff who respected their privacy and dignity and promoted inclusion. The service supported people to be as independent as they were able. We received positive feedback about the caring approach of staff.

The service put people at the centre of the care they received. Staff used detailed assessments to identify people’s needs and preferences and worked to ensure people were happy with the care they received. If people were not happy, they were confident they could speak with staff to make improvements. The service made sure people were supported to communicate and supported people with activities to enhance people’s wellbeing.

The service was led by a registered manager who people felt was approachable and caring. People felt the care they received was of a good standard and liked living at the home. The registered manager understood their responsibilities and monitored the quality of the service using a range of systems.

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 01 April 2019) where we found a breach of regulation in respect of medicines management. Following that inspection, the provider submitted and action plan to tell us how they were going to make improvements. At this inspection, we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

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

People’s experience of using this service:

People could not be assured they would receive their medicines when they needed them as medicines were not always managed safely. Medicines audits had not identified the concerns we had identified on inspection. Prior to the inspection concluding the registered manager wrote to us. They explained they had taken immediate action to address the concerns we had found.

People were asked to consent to their care. The registered manager told us they would seek support from external health professionals if mental capacity assessments needed to be carried out. We have made a recommendation about mental capacity assessments.

Risk assessments were documented and personalised to meet individual needs. Care documentation instructed staff in how risks should be minimised.

Care records were person centred and people told us they were involved in their care planning.

People who lived at the home told us they were well cared for and were supported to see medical professionals if this was needed.

People told us and we saw, that help and support was provided quickly by staff if this was needed.

People told us they were happy with the food provided at the home and we saw nutritional assessments were carried out to identify if people required extra support.

People told us the home was well organised and staff spoke positively of the support they received from the registered manager.

People were enabled to be involved in the day to day running of the home. Meetings took place to support people in expressing their views.

People were invited to take part in a range of activities. People told us they enjoyed these.

Safe recruitment procedures were carried out and staff told us they received training and supervision to enable them to fulfil their role.

People told us they were safe and staff told us they would report concerns of abuse or avoidable harm to the registered manager and local safeguarding authorities to protect people.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement. The report was published on the 7 March 2018.

Why we inspected: At our last inspection in January 2018 we identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014. We found people could not be assured that medicines were managed safely. We also noted a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014. Care records were not always reflective of people’s needs and the audit systems in place had not identified the concerns we had found. We took regulatory action and served requirement notices for these breaches of legal requirements. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by March 2018. We carried out this inspection to check improvements had been made.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the registered provider as to how they plan to address the breach in regulation and make improvements to the service.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

Primrose Bank Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Primrose Bank Rest Home provides residential accommodation for up to forty-five people and is registered to provide personal care to people who live at the home.

The property is an extended detached house situated on a main access road to Poulton Le Fylde. There is a secluded garden to the side and front of the property and car parking is available at the rear of the home. There are a range of aids and adaptations provided to meet the needs of people who live there. On the day of inspection visit there were 37 people living at the home.

At the time of inspection there was a manager who was registered with the Care Quality Commission. 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.

We last inspected Primrose Bank Rest Home in March 2016 and identified no breaches in the regulations we looked at.

This inspection of Primrose Bank Rest Home was brought forward from its initial scheduled date. This was because we had received information of concern regarding the care and support people received and the safe management of medicines. We used the information we received to plan our inspection effectively.

During this inspection carried out in January 2018 we found medicines were not managed safely. We found some medicines were not recorded within the Controlled Drugs Register and there was no guidance for staff on why and when people should receive their ‘ as and when’ medicines. In addition, we found medicines were not stored safely. We found the fridge where medicines were stored did not have the minimum and maximum temperature monitored to ensure medicines were stored at the correct temperature. We noted handwritten medicine administration records were not always signed by two staff. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Safe care and treatment.)

People told us they were happy living at Primrose Bank Rest Home and the care met their individual needs. We found people were referred to other health professionals for further guidance and advice when this was required.

We found care records did not always record the up to date needs of a people who lived at Primrose Bank Rest Home. We found risk assessments on equipment to keep people safe and promote independence were not always documented. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Good Governance.)

We reviewed the audit systems at Primrose Bank Rest Home. We found the audits had not identified the areas of concern we had noted with the safe management of medicines and care records. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Good Governance.)

We saw applications were made to ensure that where people’s rights were restricted, this was done so lawfully. We saw evidence people’s mental capacity was assessed and people were asked to consent to their care whenever possible.

During the inspection we spoke with eleven people who lived at the home. People we spoke with told us they were happy at the home and they liked the staff. People told us they were supported in the way they agreed and they enjoyed the meals provided.

People told us their privacy and dignity was respected and they took part in activities if they wished to do so. During the inspection we saw people were asked to engage with activities. We observed a meeting taking place where people could give formal feedback regarding the meal provision at the home.

There were systems to protect people at risk of harm and abuse. Staff were able to explain abuse and the actions to take if they suspected people were being abused.

We found appropriate recruitment checks were carried out. This helped ensure suitable people were employed to work at the home. We found there were sufficient staff to meet people’s needs. People were supported in a prompt manner and people told us they had no concerns with the availability of staff.

Staff told us they received regular supervisions and appraisals to ensure training needs were identified. Staff told us, and we saw documentation which evidenced staff received training and development opportunities to maintain their skills.

We viewed the kitchen and saw it was well stocked with a variety of tinned, frozen and fresh produce. All the people we spoke with told us they were happy with the meals provided and they were given an alternative if they did not like the meals offered to them.

There was a complaints policy which was understood by staff. Information on the complaints procedure was available in the reception of the home. People told us they were confident any complaints they had would be investigated. We saw documentation which evidenced the registered manager investigated and responded to complaints made. The registered manager told us they would support people to access advocacy service and we saw information was available for people to refer to.

People who lived at the home were offered the opportunity to complete surveys and meetings were available for people to participate in. People and relatives also told us they found the registered manager approachable if they wished to discuss any matters with them.

It is a legal requirement the home conspicuously displays its last CQC rating. We noted this was available in the reception area of the home and also on the registered providers website.

This is the first time the service has been rated Requires Improvement.

You can see what action we told the provider to take at the back of the full version of the report.

Primrose Bank provides residential accommodation for up to twenty-eight people. The property is an extended detached house situated on a main access road to Poulton Le Fylde. There is a secluded garden to the side and front of the property and car parking available at the rear of the home. There are regular transport links close by. There are a range of aids and adaptations in place to meet the needs of people who live there. At the time of the inspection visit there were 24 people living at Primrose Bank.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 14 August 2014 we found the provider was meeting the requirements of the regulations inspected.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care. One staff member said, “I would know what to do if I felt abuse was taking place.”

We found recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

Medicines were dispensed in a safe manner and people received their medicines on time. Staff had received related training to ensure medicines were administered correctly by knowledgeable staff. Controlled drugs were being administered at the time of the inspection visit. We found correct documentation was recorded to ensure accurate administration of controlled drugs.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

Staff had received training and were knowledgeable about their roles and responsibilities. Staff told us access to training courses and opportunities to develop their skills was good. One staff member said, “We are always encouraged to do more training.”

The registered manager had completed an assessment of people’s needs. People who lived at the home said they were happy with their care and support provided to them by caring staff. One person who lived at the home said, “We went through things, the staff were very good.”

People who lived at the home were happy with the variety and choice of meals available to them. The service employed cooks who prepared homemade meals and comments were positive about the quality of food. Regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration. One person who lived at the home said, “Good home cooking here.”

We observed staff treated people with respect, patience and dignity. People we spoke with told us staff were caring and respectful. One person who lived at the home said, “The staff and management are so good and kind towards people.”

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s wishes. During the inspection we observed people were supported to carry out activities which they enjoyed.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home.

The management team used a variety of methods to assess and monitor the quality of the service. We looked at a number of audits that had taken place. This ensured the service continued to be monitored and improvements made when they were identified. People who lived at the home and relatives had opportunities to feed back to the management team. This was about the quality of their care through surveys and meetings.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff team. People told us they felt safe and comfortable living at the home and that staff were, 'Excellent. They do all they can for you, they never get cross or anything like that. I enjoy living here'.

Medication practices were robust. Only senior staff that had received appropriate medication training had responsibility of the administration of medication. A monthly medication audit was in place. This helped to ensure that medication practices remained safe, by ensuring any shortfall was quickly identified and addressed.

The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded as required.

We looked at the recruitment of new staff. We did not see evidence to confirm that all the required recruitment checks into qualifications and experienced were obtained before the newly appointed person started their employment at the home. This potentially put people at risk of being supported by staff without appropriate skills.

Is the service effective?

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

People's health and care needs had been assessed prior to them moving into the home. This made sure that their individual needs and requirements could be addressed by the staff team. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People spoken with told us that their needs were being well met.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind, caring and attentive staff. We saw that care workers showed patience, humour and gave encouragement when supporting people. People commented that staff were, 'Kind and interested. They are very attentive, ask for help and you get it'. A relative told us, 'I think the empathy side of things they are very good at. There does not seem to be any shortage of staff ever'.

People were being supported to dress appropriately and care was taken with their hair and clothing. This indicated that staff were aware of the importance of appearance and how this impacted upon an individual's personal dignity and feeling of self-worth.

People using the service and their relatives completed an annual satisfaction survey. Where any shortfalls or suggestions were raised these were addressed. We looked at the outcomes of the most recent surveys, outcomes were all positive.

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

Is the service responsive?

People knew how to make a complaint if they were unhappy. However the people we spoke with said they had never had any cause to make a complaint. We looked at the way a complaint would be handled and the records used for recording a complaint, the method of investigation and outcome. The processes in place reassured people that any complaint would be taken seriously, investigated and action taken if required.

Is the service well led?

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

The service had quality assurance systems in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

During our inspection we used a number of observational tools to gain evidence about what it was like to live at the home. We did this by looking at care records, staff training and support records, nutritional support and evidence of how the home managed quality and listened to people. In addition we spent time in communal areas including the garden in order to speak with a range of people as well as making general observations of the routines in the home.

We were visiting the home when the evening meal was being served. This was done in an unhurried way, with people seen to be exchanging conversation with each other, as well as staff communicating positively with residents throughout this time. A visitor arrived and was seen to be made to feel welcome, sitting at the dining table with their relative.

The home had a pleasant atmosphere with residents coming and going as they pleased. Comments from people included, 'What lovely place to live. I am lucky to have such a nice home with lovely staff to help me.' Also, 'I am always asked what I would like to eat every day, there is always a good choice'.

People we spoke with told us they liked the facilities available to them at the home. This included comments about individual rooms. One person said, 'I have everything I need in here its home from home'.