Primrose Lodge Care Home

Primrose Lodge Care Home is a purpose-built residential care home providing accommodation and nursing and personal care to up to 48 people. The service provides support to younger adults, those with a physical disability and people over the age of 65, including those living with dementia. At the time of our inspection there were 38 people using the service.

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

Medicines were not managed safely. Records did not always demonstrate that medicines were administered as prescribed. There were inconsistencies and shortfalls in relation to medication stock counts, the recording of allergies, medicated patch application and ‘when required’ medicines guidance.

An effective system was not fully in place to assess people’s dependency and staffing levels. People, relatives, staff and professionals told us that there was not always enough staff to provide person centred care. We observed that care was sometimes task focused rather than person centred.

The provider had not ensured they were displaying their CQC rating on their website in line with legal requirements.

Improvements had been taken since our last inspection in relation to infection control. The home was clean and staff had access to and used PPE in line with government guidance.

People were supported to eat and drink enough to maintain their health and wellbeing. However, mealtimes were sometimes task orientated rather than person-centred. We have made a recommendation about this.

The décor of the home did not fully meet the needs of people living with dementia. There was limited signage to help orientate people. We have made a recommendation about this.

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.

Staff worked in partnership with health and social care professionals. Health and social care professionals spoke positively about the registered manager and staff and their joint working relationships.

Action had been taken since our last inspection in relation to staff training and support. A system to help ensure staff were suitably trained and supported was in place. Due to the impact of COVID-19 and the current cost of living crisis; recruitment was ongoing. Agency staff were used to cover shifts which permanent staff were unable to work. People and relatives spoke positively about the knowledge and skills of permanent staff; they were less positive about the skills of some agency staff.

Staff explained that staffing levels did affect morale at the home, since they did not always have time to provide care which was person centred. They also said they did not always feel appreciated or valued by the registered manager or provider. We spoke with the registered manager and regional manager about this feedback. They explained the staff reward systems in place and told us how much they appreciated staff and their hard work.

People and relatives spoke positively about the caring nature of staff. Comments included, “Aye they are very caring and there is one carer who is so caring with everyone. They know her needs, she looks well and has put weight on. They know everyone and their personalities. There are a lot of nice carers there” and “Everything seems to be good and settled, I think she is in a good place myself, I have watched them treat her well and other residents as well.”

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 18 January 2023). There were breaches of the regulations relating to medicines management, staffing levels, staff training and support and the management of the service. 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 that whilst the provider had made improvements in some areas they remained in breach of regulations.

This in the third consecutive inspection where the provider has been in breach of the regulations relating to medicines management and good governance and has failed to achieve a rating of at least good.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions of safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Primrose Lodge Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 3 breaches the Regulations relating to Safe care and treatment [medicines management], Good governance and the requirement to display their CQC performance rating.

Full information about CQC’s regulatory response in relation to the provider’s failure to display their rating is added to reports after any representations and appeals have been concluded.

We have made two recommendations in the effective key question. Please see this section for further details.

Follow up

We will meet with the provider following this report being published 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Primrose Lodge Care Home is a purpose-built residential care home providing accommodation and nursing and personal care to up to 48 people. The service provides support to younger adults, those with a physical disability and people over the age of 65, including those living with dementia. At the time of our inspection there were 43 people using the service.

Care is provided over two floors each with private rooms and a series of communal facilities. The upper floor supports people predominately with nursing needs, although three people with nursing needs were also being supported on the ground floor.

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

This was a targeted inspection that considered the areas; safe, effective and well led.

People were not always kept safe. Appropriate systems to manage and control infections at the home were not followed. Improvements had not been made around the effective management of topical medicines. Staffing was an ongoing issue for the provider, although appropriate recruitment processes were followed. People, relatives and staff felt there were times when there were not enough staff. Agency staff were used to supplement staffing complements, although checks on their skills and qualifications were not always carried out in a timely manner. People felt staff tried hard to support them and felt safe living at the home. Risks related to care and the environment were monitored and reviewed.

People’s care plans were detailed and reviewed on a regular basis. There were mixed views on access to training. Staff supervision and appraisals were not undertaken consistently. People had mixed views on the meals, although a new chef had recently started at the home. Fluid charts and records were not consistently completed.

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. Practice around the Mental Capacity Acting and ensuring appropriate consent had been obtained had improved.

Management of the service was of variable quality. Audits and checks were not always robustly followed up and had failed to identify gaps in records or to act when issues were identified. People’s views on the service had been sought and acted upon.

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 30 April 2022). The provider remains rated as requires improvement. This is the second inspection where the provider had been rated as requires improvement.

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 that whilst the provider had made improvements in some areas they remained in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 and 8 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve medicines management, ensuring appropriate consent was sought, develop better systems to ensure cleanliness and infection control and implement oversight and quality monitoring of the service.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Primrose Lodge Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to infection control, medicines management, staffing and oversight and management of the service at this inspection.

We have made a recommendation in relation to monitoring and recording people’s fluid intake.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Primrose Lodge Care Home is a care home for up to 48 people. The service provides care and accommodation for both older and younger people, people living with dementia and those with a physical disability. At the time of the inspection there were 43 people using the service.

The service is a purpose-built home with individual rooms and a range of communal facilities. There are two floors each with their own shared spaces, such as lounges and dining rooms. The service had people requiring a range of differing support. Some individuals were receiving nursing care whilst some people were supported only with social care.

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

People were not always supported to receive their medicines appropriately and safely. We found some medicines may not have been given in line with prescribed direction and records were not always well completed. Cleanliness at the home needed to be improved, particularly around high-risk areas that needed additional cleaning during a COVID-19 outbreak. Staff were not always following guidance regarding the correct use of PPE. Risks, both in relation to care and the environment were monitored. Staff recruitment was undertaken appropriately. People and staff felt there were times when additional support would have been beneficial to care. There was a high reliance on agency staff due to recruitment pressures. Recruitment of new staff was ongoing.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. Records did not always evidence how staff followed the principles of the Mental Capacity Act. People's needs had been assessed prior to them coming to live at the home. People were supported to access appropriate food and fluids and meals were described as being good. The premises were well maintained although some areas needed redecoration. Staff had received a range of training and development but welcomed additional specialist training. Supervision to support and monitor practice was undertaken.

People told us they were happy with the care they received, and staff were kind and helpful. People’s choices were considered when providing care and their views were considered. Staff had a good understanding of people as individuals and people were treated with dignity and respect.

Care plans were in place, but the quality of the information varied. The standard of monthly reviews was of variable quality. People told us activities were available. Many of the activities were group events and there was a need for more individualised support. Visiting was supported during the pandemic, in line with government guidance. People’s preferences and choices were considered. The home had a range of processes to support people communicating. End of life care was considered as part of the care planning process although needed to consider the wider aspects of personal and religious preferences.

There were a range of audits and checks in place, although the issues identified at the inspection had not been identified by these processes. A new manager was in post, although was not registered with CQC. Staff felt the service lacked consistent leadership and direction. Some attempts had been made to involve people and staff in decisions about the running of the home. The home worked in co-operation with a range of other agencies.

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

Rating at last inspection

This service was registered with us on 18 May 2020 and this is the first inspection under the current provider.

Why we inspected

This was a planned inspection based on the date the service had been first registered under this new provider.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last infection control inspection, by selecting the ‘all reports’ link for Primrose Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.