Archived: Priory Mews Care Home

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced. Priory Mews Nursing Home is purpose built and provides nursing and personal care for up to 156 older people, some of whom were unable to move independently. Others required support because of dementia or other age related conditions. End of life care was also provided. There were five separate houses on the site. There were separate facilities on site for the administration, catering and laundry. There were 152 people receiving nursing care at the time of our inspection.

There was registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they always felt safe in the home however we identified some improvement was needed to make sure the service was safe.

Staff received Mental Capacity Act 2005 training (MCA) and Deprivations of Liberty Safeguards (DoLS) training. However staff did not always take account of the requirements of the MCA for people who lacked capacity to make a decision. They had not understood that mental capacity assessments should be relevant to specific decisions, at the time the decision needed to be made. Care and nursing staff knew how to protect people from abuse and who to report any concerns to.

People were protected from harm because risks to their safety were assessed. People were involved as far as possible in these assessments and action to minimise risk was agreed with them. Any accidents and incidents were monitored to make sure that causes were identified and action was taken to minimise any risk of reoccurrence. Some people at the service presented behaviours from time to time which had a negative impact on themselves or others. We observed staff handling these situations well.

The provider operated safe recruitment procedures. Staff told us there was a good atmosphere and staff worked as a team. They told us there were enough of them to care for people and keep them safe. People told us they did not have to wait long when they needed help or support

Some improvement was needed to make sure the service was effective in relation to specific training. However, people and their relatives gave us many examples of where the service was effective.

Staff told us they felt well supported and were provided with training, including induction and key mandatory training, to make sure they had the knowledge and understanding to provide effective care and support for people. Nursing staff were supported to continue their professional development (CPD). All staff received regular supervision and appraisal to make sure they were competent to deliver appropriate care and treatment. However there were gaps in the knowledge of nursing staff in relation to treating people with pressure or leg ulcers which meant that they might not always receive appropriate care and treatment.

All new staff were provided with induction training and all staff received regular supervision with their line manager where they were able to discuss their work. Qualified nursing staff told us that they received regular clinical supervision and were provided with opportunities for additional training.

People told us they enjoyed the food. They said, “There’s always something available, even at midnight, if you’re hungry.” “The food here is really good.” People were offered choices about what they wanted to eat and drink. People who needed support to eat were helped discreetly. Meal times were managed effectively to make sure that people received the support and attention they needed.

People were supported to manage their health care needs. Nursing staff carried out regular health checks on people who lived in the home and these were recorded. People told us they were able to see a GP whenever they wanted to. Records showed that people saw other health professionals such as chiropodists, dentists and opticians when they needed to.

The service was caring because people were treated with respect, kindness and compassion. People told us they were happy and felt cared for. They said, “All the staff are very kind.” and, “They cannot do enough for you”. All agreed that they felt listened to.

Each person had an individual care plan. These were continually reviewed and updated to make sure all their needs were understood by staff who provided their care and treatment. People told us they had been consulted about how they wanted their care to be delivered.

People’s personal information was treated confidentially and records were stored securely. Staff were discreet in their conversations with one another and with people who were in communal areas of the home. Staff were careful to protect people’s privacy and dignity.

The service was responsive because people received personalised care or treatment when they needed it. Several people said that they never had to wait long for help, as ‘they are in and out all the time’.

Staff knew people well. We were impressed by the knowledge and understanding staff demonstrated about the people in their care. Staff were calm and patient with people, They communicated effectively, responding quickly and appropriately to people’s requests. Staff offered people choices. For example, about what they wanted to eat and where they wanted to spend their time.

People’s needs were assessed with them before they moved to the home to make sure the home was suitable for them. Care plans were regularly reviewed with the person concerned to make sure they were up to date and reflected their individual preferences, interests and aspirations. People were provided with a range of suitable activities they could choose from. Everyone we spoke with told us there were activities on offer.

The manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. All the visitors we spoke with felt able to raise any concerns with staff or the management. We saw that people were comfortable with the management team and staff in the home.

Some improvement was needed to make sure the service was well-led. However, people spoke positively about the way the home was run. They said, “It all seems to work very well.” and, “Very well managed, they know what they are doing.”

There were systems in place to regularly review the quality of all aspects of the service. Improvement plans were developed where shortfalls were identified. However quality assurance systems had not been effective in identifying where improvements were needed to ensure that the requirements of the MCA were implemented correctly to make sure that people’s rights are protected, and to make sure that there are no gaps in staff knowledge and training which might have a negative impact on people’s care and treatment.

There was an open and positive culture in the home and the organisation had clear vision and values. These values put people at the centre of the service and had been successfully cascaded to staff. People were comfortable with the management team and staff in the home. Staff understood their roles and responsibilities and the staff and management structure ensured clear lines of accountability.

Annual customer satisfaction surveys and quarterly resident and relative’s meetings gave people the opportunity to comment on the quality of the service. This showed that people were listened to and their views were taken into account in the way the service was run.

The manager had developed a Dignity Champion role in the service. This helped to ensure that staff understood and followed best practice so that people who were experiencing dementia received appropriate care and support. A local authority service commissioner told us, “There is genuine care and concern for all residents but we feel they are particularly good at dementia care.”

You can see what action we told the provider to take at the back of the full version of the report.