Prideaux House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question outstanding. At this assessment the rating has changed to requires improvement.

This meant people’s needs were not always met.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs. Care plans were not person centred. Nearly all care plans lacked personal histories and although there was an ‘about me’ section, all were blank. There were few references to people’s likes, dislikes and preferred routines. There were discrepancies in what was written in some care plans to what staff told us. For example, one plan stated a person was on continual bed rest however staff told us they sat out daily and could help with personal care. Most people congregated in the communal lounge of the service and most would have their meals in this location. Although visiting professionals did tell us that the service was responsive to them and any requests or suggestions made, however, these requests and suggestions were not always recorded or reviewed within care plans. The registered manager was aware of the issues with care plans and had begun a process of updating and reviewing but this would take some time to be completed.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. People’s health and social care needs were responded to in a timely way. A positive relationship had been developed with professionals that regularly visited the service to advise staff and to provide specialist support when needed. Relatives told us their needs were met and regular appointments and visits were made from for example, podiatrists, district nurse and GPs. A professional told us, “The home staff and systems help to ensure that residents receive the right medication at the right time, with clear documentation shared between care home and pharmacy teams.” Another added, “From my perspective and the work that I undertake with the care home I feel that care provision, integration and continuity is met for each resident, and local services support the care staff to enable them to care for the resident’s needs.”

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. Some people required support with communication and specifically understanding what staff were trying to tell them, support them with or advise them about. Although there were some support aids available, pictorial messages, to make things clearer for people, these did not seem to be used. Verbal communication was the primary means of staff being able to talk with people but we did not see many conversations held or staff spending time with people to make sure they fully understood what was happening at any given time. Staff were aware of people’s nonverbal signs, if for example, they expressed a yes or no answer of facial expressions that may indicate discomfort. However, these were not always responded to. Some relatives told us they felt communication between the service and themselves worked well and that sometimes they were asked for feedback. One told us, “They do sometimes send us a form to fill in about what we think of the home.” However, another relative added, “They do keep in touch but I’ve not been asked my views about the home.”

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result. Complaints and concerns raised by people and relatives had not been recorded or addressed by the registered manager. The registered manager told us they had received no complaints in the past 12 months and showed us an empty folder. However, we saw evidence from accidents and incidents where concerns had been raised by people and relatives that had not, at the time of the incidents, been reported. These included issues raised relating to the way some staff spoke to residents, an incident where a person was injured albeit accidentally but then no actions were taken to make the person safe and comfortable and complaints about the ongoing lack of activities for people. Resident meetings were held but the minutes showed they were focussed on specific subject areas for example, plans for a Christmas meal. There was no apparent process for people to raise concerns. It was also unclear how those people who could not physically attend the meetings, were able to make themselves heard. Relatives were unsure about who they would raise a complaint with one saying, “If I had a complaint I’d contact CQC.”

The provider made sure that people could access the care, support and treatment they needed when they needed it. People were able to access the care and support they needed when they needed it. They were supported by staff and relatives to keep appointments to make sure they received timely and appropriate care. Professionals were complimentary about the service and the proactive approach adopted to ensure people received the best care when needed. A professional said, “Based on my involvement, residents appear to have fair and equal access to services, support, and external professionals. I have not observed any barriers related to background, communication needs, or personal characteristics. Staff are attentive to individual preferences and adapt their approach where required.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. There were very few activities and events for people to be involved in each day. The service had been without an activities coordinator for several months and although the registered manager was trying to recruit into that position, there remained little for people to do. Both people and their loved ones commented on this. A person said, “There is not much to do here.” Comments from relatives included, “There is a singer that goes in every fortnight. I know it’s not much but they like it” and “It’s difficult for her to get involved with much because of her dementia. I think others would benefit if there was more to do.” Staff did what they could during quieter times to entertain people but this could not always be guaranteed due to their other caring responsibilities. A member of staff said, “We need a co-ordinator. Some days it works but can’t guarantee the amount of time. We do sit with people, chat, do crosswords. But there is a need for more.” There were no communal quiet areas where people could sit and chat with 1 or 2 friends. Most of the relatives we saw visiting, sat with their loved ones in the communal lounge area.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. There were conflicting accounts within care plans whether Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) were in place. We reviewed several care plans and some described these forms as not being in place but then later in the plan stating they were. The forms contain important information relating to advanced decisions about people’s end of life support. Similarly, Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms which described advanced decisions about care and support were sometimes referenced as being absent from care plans but then later referenced indicating they were in place. The registered manager was aware of this issue and was taking immediate steps to rectify the position and to avoid potential confusion. Discussions had taken place with most people and their relatives about end-of-life support and where people wanted to be, most stating they wanted to remain at the service and not be moved. Staff had completed end of life training although their responses to describing the important aspects of care provision at that important time for people, varied. Some were clear about making people comfortable and respecting dignity but others were unsure.