Archived: Priory Paddocks Nursing Home

Updated 27 April 2022

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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two inspectors visited the service on 26 October 2021. Following our visit, one inspector concluded the inspection remotely, this included reviewing records and gaining feedback from relatives of people using the service, staff and health professionals.

Service and service type

Priory Paddocks Nursing 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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The registered manager is also one of the providers.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us 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.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.

During the inspection

During our inspection visit on 26 October 2021 we spoke with five people who used the service about their experience of the care provided. We spoke with five members of staff including the registered manager, deputy manager, nurse and care staff.

We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision.

Following our site visit, we asked the registered manager to send us records which we could review remotely. This included a variety of records relating to the management of the service, including policies and procedures and records relating to people’s care including medicines, repositioning charts, food and fluid charts. We did not receive all the records requested, including staff training records, environmental risk assessments and checks and records which showed how the management audited and monitored the service people received.

We received electronic and telephone feedback from two health care professionals, 10 relatives of people using the service and 16 staff members, including nursing, care and domestic staff.

We gave feedback our findings of the inspection on 8 November 2021 to the registered manager, deputy manager and clinical lead nurse.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 27 April 2022

About the service

Priory Paddocks Nursing Home is a nursing home providing personal and nursing care to 30 people at the time of the inspection, some people were living with dementia. The service can support up to 40 people in one adapted building.

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

The provider had a good history of meeting standards and regulations, however, since our last inspection there had been a deterioration in the service and standards of care provided to people.

We were not provided with all the information requested during our inspection. No records relating to the governance systems and health and safety were received. Therefore, we could not be assured that the provider and registered manager’s oversight and systems to monitor the service to identify and address shortfalls were either in place or robust.

Incidents of abuse had not always been reported to the local authority who were responsible for investigating concerns of abuse.

We were not assured there were effective systems to keep people safe from harm. Risks in people’s daily lives and in the care environment were not always being assessed and there was a lack of written guidance provided to staff in how any risks were to be mitigated. We saw no evidence or received any information which demonstrated learning from incidents, and monitoring and analysis of incidents and accidents.

People’s care plans were not person centred and did not detail the needs people required to meet their specific requirements. Records relating to the care provided to people were not always complete and accurate. This was a risk of people receiving unsafe and inappropriate care.

There had been no staff training or care staff meetings since the start of the pandemic. This meant new and existing staff were not being provided with support and guidance to keep people safe and provide good quality care.

The registered manager told us about the issues they had with recruiting new staff. The provider had taken the decision to not admit any new people into the service until the staffing levels had increased. We were not assured that people’s emotional and social needs were always being met, due to the staff being busy supporting people with their personal care needs.

Medicines were being stored safely and nursing staff were able to explain the systems in place to ensure people received their medicines when they needed them. However, not all medicine administration records showed people received their medicines as prescribed.

The registered manager and staff were proud that no one using the service had contracted COVID-19. However, we found infection control processes were not robust. There were systems to support people to have visitors and a programme to test staff and people using the service.

We were told by staff about some taps, baths and showers not working in the service. Staff were, at times, transporting hot water in bowls and buckets to support people to bath and/or wash, which was not safe.

We received feedback that the call bell system to alert staff if a person needed help worked intermittently and could not be heard throughout the building. This was a risk that people may not receive the care and support they needed in a timely way.

Despite our findings we received positive feedback from people using the service, relatives and two health care professionals. All feedback received commented on the caring nature of the staff.

Feedback from staff demonstrated they were committed to providing people with good care, but were concerned about the lack of training and staffing levels. Staff were complimentary about the registered manager and their caring nature, however, some staff told us there was a lack of leadership and they did not feel listened to or supported to raise concerns about the service to the registered manager.

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

Rating at last inspection

The last rating for this service was good (published 13 November 2018).

Why we inspected

We received concerns in relation to the management of the service, the safety of people using the service and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The inspection was prompted in part by intelligence received of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. 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.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. 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 Priory Paddocks Nursing Home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, safeguarding people from abuse, the provision of staff training, and the systems to monitor the service, at this inspection.

Please see the action we have told the provider to take at the end of this report. We have added conditions to the provider's registration, these conditions ask the provider to undertake actions to provide assurances of improvement and safety. Please see the enforcement action we have taken 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 request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.