Prema Court

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. We identified a breach of regulation in relation to how the service supported people to maintain and improve their mental health. At this assessment the rating has changed to inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of the legal regulation in relation to person centred care.

This service scored 33 (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 make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

Initial assessments were completed when people moved into the home and a care plan was created. Assessments were not always up to date. Records seen showed assessments and plans were overdue a review, and some information was not reflective of people’s current needs, including Deprivation of Liberty information.

Staff told us information about people’s needs was readily available. However, the care plans we looked at had not been reviewed regularly or thoroughly and there was no evidence people or relatives were involved. This meant we were not assured all assessments were factual and captured peoples wishes and needs.

While there was an understanding from management of the importance of including relatives and those important to people in care planning, people’s relatives told us they had little, or no knowledge of the care plans. One relative said they were “Not aware of care plan or opportunities people might have to discuss these”. We found no evidence of discussions with people or their relatives to offer continuous and appropriate support and help people achieve their goals and develop independence or skills. There was a general feeling from the relatives that we spoke to that people were not supported or prompted to look after their personal hygiene.

One resident had a sight impairment and there was no on-going assessment of their needs or appropriate resources and support in place in line with the Accessible Information Standards.

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards. Nutrition and hydration needs were not met in line with current guidance.

The provider was using the Malnutrition Universal Screening Tool for identifying people at risk of malnutrition in line with best practice. However, we found regular weight monitoring of people had not been undertaken since February 2025, following the withdrawal of nursing staff at the home. Staff also told us they felt improvements were needed in relation to some people’s specific diets due to dysphasia and diabetes.

We were not assured people’s nutritional and hydration care needs were being met. One person’s records indicated they were susceptible to weight loss and their weight records indicated a continued loss of weight. Their care plan stated they should be encouraged to eat 4 small meals a day, but there was no evidence they were being encouraged and supported to eat regularly to maintain their weight.

Records also showed that their fluid intake was not being monitored. Over a 10-day period records showed 0ml offered and 0ml taken. This was concerning, as refusing meals and weight loss was identified as an indicator of mental health relapse.

One person’s care plan stated the nurse was to regularly assess mood and mental state due to the person suffering with low mood and depression. There was no evidence of this or information about how this was to be implemented now there are no nurses employed at the service.

Best practice guidelines were not followed for one person who had impaired sight and would repeatedly ask what time it was. There was no on-going assessment of their needs or appropriate resources and support in place. They were not provided with any materials or resources to offer stimulation, reassurance, or support.

The care plan for one person stated that they should be encouraged to build a routine and include therapeutic activities. The care plan also states that they should be encouraged to eat in communal areas. Their daily notes showed this person spent a large majority of their time in their room with little or no contact with staff or the other people living in the home.

Plans for transition and referrals to other agencies were not consistently made so people’s individual needs and ongoing care arrangements meet expected outcomes.

The service works with a local clinic to provide depot injections to some people who live at the service. While there was some evidence of the GP being contacted in daily care notes this was not consistent. One person was documented as having high blood pressure on two occasions, but it did not appear any medical advice was sought.

Feedback from relatives was mixed. One person said they felt there was “good co-ordination with local health services” and that their social worker is attending ongoing care review meetings which the manager of the home attends and they feel there has been “good communication between the parties.” Another relative said they could not comment on what mental health support was provided and another said their relative needed to see a dentist. However, we were told everyone was on a waiting list for the dentist and the registration details were on file; and annual health check had been carried out in the last twelve months.

The care plans we reviewed did not facilitate effective working between staff and agencies as some of the information in them was inaccurate or out of date, including information relating to Deprivation of Liberty (DOLs) and hospital packs used when people are admitted to hospital.

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

There was a lack of meaningful activities at the service and people were not supported to develop their personal interests in order to promote positive well-being and mental health. One person’s care plan stated they were interested in gardening however their daily care notes did not include any activities related to this. The reports from the daily activities tracker showed the majority of people spent a large amount of time in their rooms with some accessing the community mainly to go to the shop. There were no person-centred activities that offered stimulation or development of skills.

People were not supported to develop independence, for example one resident enjoyed cooking but was not encouraged or supported adequately to develop confidence in this skill, for example to cook for other people in the home.

The relatives we spoke with said there was a lack of support from staff assisting people to maintain personal and dental hygiene, this included people who previously took good care of themselves. They reported their relatives were in dirty clothes with long and dirty fingernails.

As identified during our last assessment there was a lack of support to help people maximse their independence, choice and control.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

People were not regularly assessed, and their care plans did not always reflect their current needs. One person’s care plan stated they were at risk of losing weight and should be encouraged to eat and drink regularly. Their food and fluid charts showed large gaps where food and fluid had not been offered or consumed.

Systems to monitor people’s care and outcomes were ineffective. The clinical audit had recorded one person had lost a significant amount of weight, but no further actions had been implemented to assist the person to gain weight.

Adequate attempts and efforts were not made to support those with more complex mental health needs. One person’s care plan stated they took time to build trust with people and that they should be encouraged to build a routine, include therapeutic activities and eat in communal areas. However, this person’s care notes did not show any evidence of this, and they spent the majority of their time in their room, becoming increasingly socially isolated. Their care plan had been reviewed but no changes or strategies had been implemented to help support this person more effectively.

The service no longer used a recovery star model, which aids people’s recovery and supports them to move on to more independent settings. However, this was still referred to in people’s care records. Signs people may be having a mental health relapse were not clearly identified so early interventions could be made.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Care plans did not accurately reflect people’s needs and preferences. People’s views and wishes were not consistently taken into account when their care was planned. Family members told us they had very little knowledge of their relative’s planned care.

Systems and practices were not in place to ensure people understood the care and treatment being offered or recommended. One person had very little interaction with staff and food was left outside their door instead of attempts being made to interact with and support the person to eat with others in the communal area.

Staff said they felt able to raise any concerns and were aware of Deprivation of Liberty (DoLS) procedures. However, information about those people subject to a DoLs was inconsistent and inaccurate. This meant it was not clear to staff who had capacity to consent or where decisions were to be made in the person’s best interest, so their views and wishes were still taken into account.

Although training was completed by staff there was a lack of training relevant to the specific needs of people. This included mental health, addiction and de-escalation techniques so staff were equipped to safely and effectively engage and support people in a way they wanted and needed.