Prema Court

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant people were not always well-supported, promoting their dignity.

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Care and treatment were not always delivered in a way which promoted people’s dignity to achieve the best possible outcomes for them.

Staff appeared to understand people’s individual needs and engaged with them in a polite manner. Staff said they prompted people to attend to their own personal care, so their dignity was maintained. However, we were told some people were reluctant to do so. From our observations we saw some people looked dishevelled.

Whilst staff were described as ‘helpful’ and ‘pleasant’, some people’s relatives did not always feel there was adequate support provided to assist people in meeting their care needs. From our observations we found some people looked unkempt.

One relative told us, “Noticeable deterioration in [persons] care such as long, dirty disgusting fingernails, needing a haircut and dirty/unkempt clothes.” Another relative added, “The state of [person], they look awful”, citing a lack of support to maintain their personal care and appearance. Whilst a third relative added, “No great concerns about care, the staff are adequate for his needs.”

Staff had completed training in dignity and respect. This training should enable staff to promote a more supportive and effective environment, improving people’s mental well-being and encouraging better cooperation with their treatment plans. However, we found little evidence this was delivered in practice.

The provider did not treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. The provider did not take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

Interactions between people and staff were seen to be polite and respectful. We did see one person assisting the maintenance man as they enjoyed taking part in DIY. Another person was seen returning from church, which they enjoyed. However, we found no meaningful structure to people’s day which considered their individual wishes and preferences.

The relative of one person spoke about a long standing member of staff being ‘very knowledgeable’ in the care and support of their family member and knew them well.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Feedback was mixed about the flexibility of support available to people. Whilst some people were able to come and go freely, others required support when accessing the wider community. Staff arrangements were not always flexible in facilitating such support. Staff said they spent a large part of their day cleaning bedrooms.

Most people were said to be independent in making decisions about their daily routine and meeting their care needs. Whilst staff provided prompts and encouragement people often refused staff support and did not maintain their personal care.

We were told one person was planning to move to alternative living, when they had their own accommodation with a reduced level of support.

The provider did not listen to or understand people’s needs, views and wishes. Staff did not respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

We observed lunch time during our site visit and found people were unable to eat their lunch in a peaceful environment due to the presenting needs of another person. It was evident this was causing other people to become upset and not want to remain in the dining room. Staff did not attempt to intervene and support any of the people affected which meant people were shouted at, spoken to inappropriately or had their meal disturbed. One person told us, this was a regular occurrence, and the provider had not considered any other interventions to support people’s immediate needs during mealtimes.

Two people had been given notice to leave the home after being found smoking in their bedroom. There was a process in place to help manage this such as increased checks and one to one discussions. The records for one person reviewed stated they should be checked every 30 minute when in their room and have one to one sessions to discuss their smoking behaviour. A review of their records provided no evidence of either of these taking place. Those people who continued to smoke in their rooms were at risk of becoming homeless.

We received a mixed response from staff about there being enough staff to support people when they wanted the support. Some people were able to go out when they wanted to. Other people, due to their support needs, had to go out with staff and would need to wait until staff were available. Due to people’s mental health needs, they did not always accept the support offered. However, at other times there was little interaction with people.

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Staff said they felt they could speak with the manager and there was good teamwork within the team. Staffing arrangements and the allocation of work had been discussed at a recent team meeting. However, staff told us they did not always feel there were enough staff on duty, and they would be allocated an area to work alone with people.

A review of accident and incident reports showed incidents often involved displays of verbal and physical aggressive. One staff member reported they were ‘frightened’ during an altercation. There was no evidence to demonstrate how the provider had supported staff effectively to manage these types of incidents to ensure theirs and the people who lived at the service safety, further information on this can be found in the safe and effective staffing section of this report.

The service was no longer supporting people using the ‘recovery star’ model. No alternative model had been introduced and training to support staff in managing difficult situations had still not been provided.