We carried out a review of the data available to us about Priors Piece on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Priors Piece, you can give feedback on this service.
Cleaning schedules and procedures had been enhanced to include more frequent cleaning of touch points such as handrails and light switches. However, we found some aspects of the service did not appear clean. We discussed what we found with the registered and senior managers who provided assurance action would be taken to address these concerns
We found the following examples of good practice.
There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing. Visitors were asked to consent to a rapid COVID-19 test, have their temperature checked, wash their hands and complete a health declaration before they would be allowed to enter the building.
Staff had received additional training in infection prevention and control and the use of PPE
There were sufficient stocks of PPE available and staff were seen to be wearing PPE appropriately.
People and staff took part in regular COVID-19 ‘whole home’ testing. People and staff who tested positive, followed national guidance and self-isolated for the required amount of time.
Risk assessments were completed for all people living at the service and additional measures put in place when people had been assessed at higher risk of infection.
The provider had developed specific COVID-19 policies and procedures which had been reviewed and updated where necessary in line with the latest guidance.
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, both were looked at during this inspection. At the time of the inspection there were four people living at the home. Priors Piece belongs to a group of homes owned by The Community of St Antony and St Elias. The homes act as a community with group activities and group management meetings and oversight.
At our last inspection in March 2016 we rated Priors Piece overall as good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the home has not changed since our last inspection.
The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.
People told us they were well cared for and said they felt safe living at the home. The registered manager and staff were aware of how to keep people safe. Staff had received safeguarding training and could describe signs that may indicate someone was at risk of abuse or harm.
Risks had been appropriately assessed and staff had been provided with information on how to support people safely. People’s medicines were managed, stored and administered safely and appropriately, by staff who had been trained and assessed as competent, to do so.
Staff were recruited safely and there were sufficient numbers of staff deployed to meet people's needs. Staff told us they felt supported and we saw evidence staff had received induction, training and ongoing supervision.
People's healthcare needs were monitored by staff and people said they had access to
healthcare professionals according to their individual needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the home supported this practice.
The home remained responsive to people's individual needs. Care and support was personalised to each person which ensured they could make choices about their day to day lives. People knew how to make a complaint and felt confident they would be listened to if they needed to raise
concerns.
People benefitted from a home that was well led by a manager who was open and approachable. The provider had systems in place to review, monitor and improve the quality of service provided. This included a programme of audits and checks, reviewing medicines management, quality of care records, support to staff and environmental health and safety checks.
The home was clean, maintained and people were protected from the risk and/or spread of infection as staff had access to personal protective equipment (PPE).
Further information is in the detailed findings below.
The home has 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
This inspection took place on 22 March 2016 and was unannounced. At the time of our inspection there were three people using the service. People had a range of needs with some people being more independent and others requiring more support with their care.
We had carried out a previous inspection of Priors Piece on 29 January 2014 and found them to be meeting the regulations we inspected.
People who lived at Priors Piece received effective support which met their individual needs. The Community held values which revolved around people being seen as individuals and being supported to lead more independent lives through activities and proactive support. Staff at Priors Piece believed in these values and demonstrated these through their practice.
Each person’s care needs were assessed on a regular basis and risks were identified and acted upon. Clear and detailed management plans were in place in relation to each person’s needs. These gave staff information about each person’s specific needs, how these presented themselves, and how to ensure people’s wellbeing was maintained. People were encouraged to become as independent as possible and were supported to develop their skills. People’s skills were reviewed yearly in order to ascertain how people had progressed and which areas they needed to gain further skills in. Healthcare professionals spoke highly of the home and told us people’s abilities grew when they lived in Priors Piece. One healthcare professional said “I cannot speak highly enough about Prior’s Piece. They have turned the life around of one of my service users”.
Staff at Priors Piece had great respect for the people they supported and valued their dignity and self-esteem. Where staff provided people with support this was done in the most discreet way possible and staff were highly aware of not wanting to pressure people or underestimate their intelligence. Staff spoke very highly of the people in Priors Piece and spoke of their great intellect and abilities. Staff knew people well and were knowledgeable and confident when they spoke about people’s support needs. Staff knew people’s histories, their likes, dislikes, interests and preferences. Priors Piece had a very homely atmosphere and throughout the day we observed positive interactions between people and staff as well as laughter, joking and chatting. People’s privacy was paramount and each person had a key to their room. Staff did not enter people’s rooms without permission.
Staff had received training in, and understood, the principles of the Mental Capacity Act 2005 and the presumption that people could make their own decisions about their care and treatment. Some people who lived in Priors Piece did not have the capacity to make specific decisions at specific times. Where this was the case staff had followed the principles of the MCA, the Mental Health Act and decisions had been made in the person’s best interest. The registered manager had a good understanding of the laws regarding the Deprivation of Liberty Safeguards and had made one application to the local authority which had been authorised.
People felt safe at Priors Piece and staff had received training in safeguarding people from possible abuse. Staff knew how to raise concerns if they were worried about anybody being harmed or neglected. Staff had received information about whistleblowing and felt confident about doing this if they needed to. People and staff felt confident any concerns they had would be acted upon quickly and effectively by the registered manager.
People spoke highly of the staff and staff had enough time to meet people’s individual needs. Staff supported people to attend activities, tend to people’s needs and spent time individually with people. People had access to a wide variety of activities which met their individual preferences and interests. There was a comprehensive activities programme which some people took advantage of and people also engaged in their own activities, either on their own or supported by staff.
Staff received sufficient training to meet people’s needs well and further training was available to those who wanted it. Staff were encouraged to gain further qualifications and pursue their interests through further training. There were robust recruitment processes in place to ensure that suitable staff were employed. Staff performance was monitored with supervisions, appraisals and spot check observations. Poor practice was picked up and acted on and staff knowledge was regularly tested. Where staff did not answer test questions to the registered manager’s satisfaction, they received further training and coaching.
Staff were encouraged to share their views and ideas in the form of supervisions, team meetings and staff handovers. Staff felt confident the registered manager valued their ideas and implemented them where appropriate.
People told us they felt safe and well looked after. Staff had received training in safeguarding people and knew how to raise concerns if they were worried about anybody being harmed or neglected. Staff had received information about whistleblowing and felt confident about doing this if they needed to. Staff knew how to raise concerns and contact details for external bodies were available. People and staff felt confident that any concerns they raised would be acted upon quickly and effectively by the management. There were robust recruitment processes in place to ensure that suitable staff were employed. Poor practice was picked up and acted on and staff knowledge was regularly tested. Where staff did not answer test questions to the registered manager’s satisfaction, they received further training and coaching.
Where risks were identified in relation to people’s mental health, their general health, their wellbeing or their safety, these had been assessed. Staff had sought advice from external healthcare professionals and had created plans to minimise risks for people. People’s care plans and risk assessments were regularly reviewed and updated with any changes.
People were supported to take their prescribed medicines by staff who had been trained in medicine administration. Medicines were managed safely. People were referred to external healthcare professionals where necessary.
People at Priors Piece were supported to eat and drink enough to ensure they maintained good health. People were provided with healthy balanced meals which met their preferences and people could make choices with regards to their food. People’s diets and preferences were catered for and people were encouraged to help themselves to drinks and snacks throughout the day.
People and staff spoke highly of the registered manager. The leadership structure at the home was clear and staff were confident in their responsibilities. The registered manager had an effective quality monitoring system in place which was used continually to review and improve the service provided. People’s views, opinions and feedback were sought through the means of meetings and questionnaires.
People received good quality of care and support at this service. People's choices were promoted at all times and staff understood each person's support needs.
Staff made the service as homely as possible. People told us they were happy. One person told us "It's nice here, really nice". Another person said the service was "the best place I've been in. I do lots of things, when I want to".
One person showed us their room. They explained to us that they had the room as they wanted it and were very happy at this service. They told us "I do not want to move. Ever"
There were procedures in place to keep people safe. Staff were knowledgeable about safeguarding and people told us they felt safe. One person said "I'd be more than happy to talk to anyone here if I really had to".
The service had a quality assurance system that monitored standards and looked to improve where possible.
We found that the people who lived at the home were supported by enough staff all of whom had been trained to understand and meet their needs. There were procedures in place to help safeguard people from harm. We noted that some of the policies and procedures were in need of revision. And likewise some staff training was overdue for refreshing.
The people who lived there described a sense of ownership. One person told us "oh I have been here years now. It's fine. I like it here. It makes me happy." A member of staff explained "We try and fill every day with as much as we can do". We were told "family can visit whenever....it is nice cos it's like a homely place to visit."
We saw that people were encouraged to take pride in their home. While we were there we saw one person helping with lunch preparation. Later another person laid the table for tea. We saw that the people who lived at Priors Piece, and the staff who worked there, all knew each other well. There was a sense of mutual affection and respect.