Archived: The Priory Residential Care Home

Updated 8 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014. We were also visiting to inspect the action taken by the provider to address enforcement action by the Care Quality Commission (CQC).

We have completed four comprehensive inspections and two focused inspections since a comprehensive inspection in December 2014. In a focused inspection in May 2015, we followed up on a previous warning notice relating to governance of the service; this had not been fully met. In a comprehensive inspection in May 2016, we found there had been improvements, although further work was needed to sustain and embed the changes. A further focussed inspection took place in August 2016, which was in relation to concerns raised about the quality of people’s care and to check whether the service was compliant with enforcement action. On both of these inspections, the service had not improved enough to address the enforcement action.

We visited the home on 1 and 8 December 2016. The visit was unannounced and was carried out by one inspector on the first day and by one inspector and a pharmacist inspector on the second day. The service provides accommodation without nursing care and is registered for 21 people to live at the home. When we visited there were 12 people living at the home and one person staying there temporarily.

Prior to the inspection we reviewed a range of information to ensure we were addressing potential areas of concern and to identify good practice. This included the Provider Information Record (PIR), which asks the provider to give some key information about the service, including what the service does well and improvements they plan to make. We also reviewed previous inspection reports and other information held by CQC, such as notifications. A notification is information about important events which the service is required to tell us about by law.

During the visit we met 13 people living at the home; five people shared their views on living at The Priory Residential Care Home. We spoke with one visitor to the home, seven staff and the registered manager who is also the provider. We contacted the district nursing team, visiting health and social care professionals, GPs and the local commissioning and contracting team, plus the local authority quality improvement team. Five health professionals and two social care professionals responded to our request for information. We also gained permission from visiting health and social care professionals to use information from their recent reports following visits to the home.

We observed care and support in communal areas and also looked at 12 people’s bedrooms and two bathrooms. We reviewed a range of records about people’s care and how the home was managed. These included the care plans for three people, the training and induction records for three staff employed at the home, the recruitment files for three staff working at the home, training records for staff and 13 medication records. We also discussed the quality assurance audits systems with the registered manager and the deputy managers.

Updated 8 March 2017

We visited the home on 1 and 8 December 2016. The purpose of this inspection was to judge if the service had improved after a number of breaches of regulation were identified on two previous inspections in 2016.

Following our inspection in May 2016, we served two warning notices, relating to staffing and good governance. In August 2016, we re-visited the home due to concerns regarding people’s safety and found the staffing warning notice had not been met. During our current inspection, we found a new breach and four on-going breaches of the Health and Social Care Act 2008 and associated Regulations and a new breach of the Act; this included the warning notices for staffing and good governance which still have not been fully met. The service was part of a whole home safeguarding process and was being visited by a range of health and social care professionals. They were also being supported by the local authority’s quality assurance and improvement team.

There was a registered manager. 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.’ The registered manager is also one of the directors of the registered provider. Throughout this report we have referred to the registered manager. There are also two deputy managers who the registered manager has delegated some managerial duties to.

The service lacked effective leadership and the management style was often reactive rather than proactive. There was not an effective system to regularly monitor and assess the quality of the service and the risks to the people living there. This meant improvement had not been made in some areas of care and new areas of concern had not been addressed or identified.

Previous inspections by CQC had highlighted concerns regarding staffing levels and the registered manager had not effectively monitored if staffing arrangements kept people safe and met people’s physical and mental health needs. We identified concerns about staffing levels in the evening at this inspection. People did not always receive care at a time convenient for them and lacked adequate supervision in communal areas.

People were supported to see, when needed, health care professionals. Care staff recognised changes to people’s physical well-being and knew to share this. However, some aspects of medication administration, storage and recording were poorly managed.

Safety checks were carried out but some areas of the home were potentially unsafe to people living with dementia. Aspects of infection control practice did not protect people from the risk of cross infection. The reporting of safeguarding issues by the management team had improved. However, some staff did not have the knowledge and confidence to identify safeguarding concerns and act on these to keep people safe.

Applications had been made for Deprivation of Liberty Safeguards (DoLS) assessments for people living at the home. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Discussions between the registered manager and deputy managers highlighted there was a lack of clarity whether the applications were appropriate for all of the people living in the home. However, people’s consent for day to day care and treatment was sought by staff.

In one aspect of the recruitment process, there had been improvement to make it a safer process, but there were still gaps in recruitment information. This meant potentially people unsuitable to work with vulnerable people had not been identified. People living at the home were cared for by staff who had not been appropriately supported through induction and training. However, throughout our inspection we saw people were supported in a kind and caring manner by staff who knew them well. Staff spoke about people in a compassionate and caring manner. Staff showed a strong sense of loyalty towards the people living at the home. Most people said they felt safe and comfortable.

People were positive about the quality and range of food at the home. They said the food was well cooked and they enjoyed their meals. People were supported to ensure that they had enough food and fluid to support their health needs. However, recording was not consistent to help manage the risks to people’s health.

There was an effective complaints system to address people’s concerns. Activities to motivate people and promote a positive well-being were available, but there was not a system in place to ensure activities happened regularly to meet people’s individual interests.

During the inspection we identified four continuing breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were at risk of harm because the provider’s actions did not sufficiently address the on-going failings. There has been on-going evidence of the provider’s failure to sustain full compliance since 2014. We have made these failings clear to the provider and they have had sufficient time to address them.

We are taking further action against this provider and will report on this when it is completed. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

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

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

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. Following the inspection, we shared our concerns with the local authority safeguarding team and commissioners.