Archived: Primrose House

Primrose House provides care and accommodation for up to five people with learning

disabilities, Asperger’s or Autism. On the day of our inspection there were five people living at the service.

People’s experience of using the service

People using the service benefitted from caring, dedicated staff. Not all people living at Primrose House were able to verbally express their views, but we observed they looked comfortable and at ease with staff. Their non-verbal body language, facial expressions and laughter indicated they were happy.

People and their families, if appropriate, were placed at the heart of the service and involved in decisions as far as possible.

People’s care was provided safely. The staff team were consistent, staff knew people well and people were supported where required and if needed when they were out of the home.

People’s medicines were well managed.

People’s risks were known and managed well, promoting independence as far as possible. Staff were aware of people’s risks and supported people to reduce these as far as possible.

People were protected from discrimination because staff knew how to safeguard people. Staff knowledge of people meant they were alert to signs of change which may indicate someone was not happy.

People lived in a service which had a positive culture and was led by a caring management and staff team.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; independence, choice and control over day to day routines and inclusion and involvement in the local community. People's support focused on them having as many opportunities as possible for them to gain new skills and develop and maintain their independence.

Primrose House has worked in partnership with the local authority, commissioners and learning disability service in the past 12 months to improve the quality of care provided.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (The last report was published 3 July 2018). At this inspection the overall rating had improved to Good.

Why we inspected:

This was a planned inspection to look at improvements the service had made following the previous rating. At this inspection we found improvements had been made.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

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

Primrose House is a small, family run home for up to five people learning disability, Asperger’s or Autism. On the day of the inspection five people were using the service.

Primrose House is a large terraced house and offers residential care without nursing. There were shared bathrooms, a communal kitchen, a communal lounge, a dining area and a garden.

At the last inspection on 15 May 2017, the service was rated as requires improvement in two key questions, Safe and Well-Led. This was due to staff recruitment processes not being thorough, risks to people and the environment not being well assessed and managed and quality assurance systems needing improvement. At this inspection we found some improvements in these areas but further development was required to medicine management, staff training and the governance systems to ensure regulatory requirements were understood, met and the service continued to improve. Therefore we rated the service again as Requires Improvement overall.

Throughout the inspection we were assisted by the registered manager who was also the provider. The service had a registered manager in post. 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.

Medicines were administered consistently and safely. No one was on medication without their knowledge (covert) and no one was prescribed medicine which required additional storage for safety purposes. Staff confirmed they understood the importance of safe administration and management of medicines. We looked at medicines administration records (MAR) and noted all had been correctly completed. Some people managed their own medicines and staff checked they were doing this safely at intervals. The service had a medicines policy but it required updating to reflect current best practice. Some staff had not had formal medicine training either or an assessment of their competency. We also talked to the registered manager about developing “as required” medicine support plans and a recorded system to check the medicine administration records. Although we did not identify medicine management was unsafe at the inspection and there was no impact on people’s care, systems needed to be more robust to reduce potential error.

Primrose House was run like a traditional family home might be. There were some informal quality assurance systems / checks in place for example room checks and checks on people’s medicines. Feedback from people, staff, relatives and professionals was noted, listened to and action taken. Learning and reflection took place in the event of an incident or concern raised and these were used to help drive improvements to people, but there was limited documentation to support these processes. Links with forums which discussed best practice in this area was limited and policies and procedures required updating to reflect current practice. More formal governance processes to checks that standards were maintained would support the development of the service.

People were supported by staff that had received an induction programme and some staff were undertaking further qualifications in health and social care. Staff training however required updating in some areas, for example safeguarding, fire training, medicine management and the Mental Capacity Act.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. The registered manager (also the provider) was committed to employing people with the right skills, values and attitude to work with vulnerable people.

On the day of the inspection staff within the service were relaxed, there was a calm and friendly atmosphere. People went about their usual routines and led busy, active lives swimming, shopping and meeting friends. Staff had a clear role within the service and knew what their plans were for the day. Information we requested was supplied promptly, support plans were organised, clear, easy to follow and comprehensive.

Some people had limited verbal communication skills but we observed they felt comfortable with staff. People’s individual communication styles were known if people were unable to communicate verbally. Care records were personalised and gave people as much control over aspects of their lives as possible. Staff responded quickly to people’s change in needs and were sensitive to people’s moods. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported, however we found more formal reviews of care involving professionals were overdue. We contacted the local authority so people’s care was reviewed as required. People’s preferences and routines were identified, known by staff and respected.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff had appreciation of how to respect people’s individual needs around their privacy and dignity. Staff were conscious of behaviours people might display which could compromise their dignity, for example wearing clothes which were inappropriate for the weather.

People’s risks were managed well and monitored. People were promoted to live full and active lives. Staff were motivated and creative in finding ways to overcome obstacles that restricted people’s independence.

People we observed were as safe as possible. The environment was clean, uncluttered and clear for people to move freely around the home. Staff discreetly monitored people’s behaviour and interactions to ensure the safety of all the people and staff at the service. All staff understood safeguarding and signs to look for, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by staff that confidently made use of their knowledge of the Mental Capacity Act (2005), to make sure people were involved in decisions about their care and their human and legal rights were respected. Families were involved in decision making where appropriate and advocacy services were used when required. We found the recording of best interest decisions made by staff required improvement. The service followed the laws and processes in place which protect people’s human rights and liberty. Deprivation of Liberty Safeguards (DoLS) were understood by the registered manager and staff. Those who had restrictions in place had the required legal authorisations.

No complaints had been received by the service. The registered manager advised if a complaint was received it would be managed in line with the provider’s policy and procedure. Easy read, pictorial formats were available for people who were unable to verbally communicate their concerns if required.

The service had started to work alongside the quality assurance team to make improvements.

We found two breaches of regulations.

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

The person in day to day charge of the home was the registered provider. Registered persons have the 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 of the service on 24 and 25 February 2015, the service was rated as good. One key question was rated as requires improvement (Safe). This was due to concerns over the recruitment process in place. On this inspection we found that other improvements were needed and the home was rated as Requires Improvement.

We found that people who lived at the home were well supported, and received opportunities to lead full, active and interesting lives of their choosing. The home had a positive culture and family like, informal atmosphere, and people told us they were happy living there.

However, some management and governance systems were not well developed or organised. We found policies and procedures were out of date and some records were not well maintained.

Not all risks to people were being assessed or managed, including where risks had altered. We found some risks in relation to the premises had not been assessed or actions taken when a person’s needs had changed.

People were not always kept safe because staff were not always recruited in a way that helped ensure people’s safety. At the last inspection we had identified a concern over some checks not having been made at the point of recruitment of staff. The provider told us they had taken action, and we saw they had obtained the specific checks retrospectively. However on this inspection we found they had still not carried out all the checks needed when recruiting staff or put in place a system to ensure this was done in future.

We did not identify that these areas impacted directly on people’s care; however there was a risk of this happening.

People were protected because staff understood how to raise concerns about abuse and how to protect their rights. Support had also been given to people to help ensure they understood how to raise any concerns they may have. Where people had been assessed as lacking the capacity to make decisions for themselves the home had taken appropriate actions to protect people’s rights, including formal advocacy services. Personal responsible risk taking practices promoted and protected people’s freedom, choice and rights.

People were involved in the running of the home and had strong links with the local community in Ivybridge and the surrounding area. Care plans were regularly reviewed and detailed any areas of need and how they were to be met. People followed activities of their choosing, including sports and leisure, daily household tasks such as cooking and laundry and socialising with friends. People had been involved with staff drawing up plans for both long and short term goals and how they could be achieved.

There were sufficient numbers of skilled and trained staff to support people, and people were encouraged to be as independent as they wanted or needed. Although staff training systems were not well organised, we saw staff supported people with a consistent approach and appropriate communication to meet the person’s needs. It was evident there were good caring and supportive relationships in operation, and a positive culture.

People received their medicines safely. Medicines were stored and administered safely. Some people managed their own medicines with staff overview. This included lockable storage in people’s bedrooms. People could also lock their bedroom doors to maintain their privacy if they wished.

People were supported to have their health and dietary needs met. People were encouraged to be independent with making their breakfasts and packed lunches, and we saw people helping themselves to meals, snacks and fruit throughout the day. People offered to make hot drinks for others and staff throughout the day and had open access to the kitchen at any time. Where there were concerns over people’s dietary intake or health needs the provider had sought appropriate advice and support from medical professionals.

We identified three breaches of regulations on this inspection. You can see what actions we have told the provider to take at the end of this report. Further information is in the detailed findings below.

We saw that people were able to lead an active and busy lifestyle. People told us about the activities they enjoyed such as regular college courses, art and craft groups and use of community facilities including the local sports centre and coffee shops. One person said " We are always busy doing the things we enjoy and then we tend to get together and chat at tea time"

We spoke to people about the food in the home and asked if they had a choice about what they wanted to eat. One person said " We have anything we want, too much sometimes, there is always lots of lovely food available for us" Another person said " We have a takeaway on Saturdays, and we can help ourselves to snacks and drinks at any time.

Since the last inspection the provider had developed an easy read leaflet for staff and people who used the service about keeping safe and what people needed to do if they suspected an incident of abuse. All the people we spoke to were aware of this updated information.

We saw that the environment was well maintained and people were able when possible to be involved in the running and organisation of their home.

People we spoke to said that they knew who to speak to if they had any concerns. One person said " We either talk all together at the tea table or individually with staff"

We saw that people were relaxed and happy in their home. One person said 'I love living at Primrose House, the staff have helped me with my independence, I have lots of friends, here and at work'

We saw that staff treated people respectfully at all times, promoting choice and independence whenever possible.

People had been involved in discussions about their support and were able to look at their records and personal information. This involvement ensured that people's specific needs and wishes were understood and taken into account when planning care.

Care plans were detailed and included information about how people wanted and preferred to be supported. This ensured that the care provided was consistent and met people's specific needs and choices.

People were able to maintain contacts with family and friends and were able to lead a busy and active lifestyle. We saw that due to the location of the home people were able to access local community facilities independently.

People using the service were advised about issues relating to safety. However, guidelines were not in place for staff to follow to ensure that people were protected from the risk of abuse.

Sufficient staffing levels and staff training opportunities were available to ensure the needs of people using the service could be met.