Background to this inspection
Updated
15 December 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 4 inspectors, including a medicines inspector, and 2 Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
Priory Mews Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Priory Mews Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. There was a manager in post and they had made an application to register with CQC, on 28 September 2023, and this was in the process of being considered.
Notice of inspection
The inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority including their safeguarding team and commissioners, professionals who work with the service and the local Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We used all this information to plan our inspection.
During the inspection
We spoke with 16 people who used the service and 9 relatives about their experience of the care provided. We observed the care provided within the communal areas. We spoke with 29 members of staff including the nominated individual, a director, members of the management team, senior care workers, care workers, agency staff, activities co-ordinators and domestic staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included 17 people's care records and 20 medication records. We looked at 6 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including auditing and monitoring records and policies and procedures were reviewed.
Updated
15 December 2023
About the service
Prior Mews Care Home is registered to provide personal and nursing care to up to 156 people. At the time of the inspection 86 people were living at the service. Priory Mews Care Home is purpose built and arranged across 5 separate buildings (referred to as units in this report). Cressenor and Mountenay have capacity for 42 and 30 people respectively and provide nursing care for people living with dementia. Beaumont has capacity for 30 people and provides general nursing care. Marchall has capacity for 23 people and provides residential care for people living with dementia. Berkeley has capacity for 15 people and provides general residential care for older people. A separate building houses the management and administration offices, kitchen, reception and training facilities.
People’s experience of the service and what we found:
Although improvements had been made to the identification and mitigation of individual risk, further improvement was ongoing to ensure people’s safety.
Further improvements were needed to the management of people’s medicines, although this area had improved since the last inspection.
The provider had introduced new monitoring systems since the last inspection, however these were not always robust and required further improvement to make sure people received safe and good quality care.
Not all staff understood how to raise concerns outside of the organisation. We have made a recommendation about this. Not everyone had an end-of-life care plan that set out their wishes. We have made a recommendation about this.
Care plan development was still ongoing, and some care plans did not provide the information and guidance necessary for staff to fully understand people’s support needs. During our inspection the provider put measures in place to address this. We will check the progress of this at our next inspection.
Staffing levels had improved, and safe staff recruitment practices were now in place. The levels of agency staff had significantly reduced and the agency staff supporting people now were regular agency staff who were considered as part of the team. Cleanliness in the service had improved and there were no areas that were unclean, so the risks around infection control had reduced.
People’s needs were now better assessed so care plans could be written in a more individualised way. Improvements had been made to the premises so people were living in a more pleasant environment. Staff had completed their training and were more able to put this into practice. Staff said they felt well supported. People received better care with their health needs and the advice of healthcare staff was now followed. People were happy with the food provided, and their meals, and told us they could choose other options if they wished.
People’s care had improved, and staff treated people with kindness and respect. People and their relatives told us they were happy with the care provided and felt staff knew them well and understood them.
People now had the opportunity to engage in activities, visits out, or chatting with staff to enable a more meaningful day. When people and relatives complained or raised a concern, these were now investigated, and lessons were learned.
Staff said they felt listened to and were able to speak up if they needed to. Staff had only positive things to say about the provider and manager and were happy with the changes being made, such as the new electronic care planning system and improvements to the environment. Staff culture had improved and there was a happy atmosphere across the service. The provider had engaged with people, relatives and staff, through meetings and surveys. The provider had submitted notifications to CQC as required since the last inspection.
Rating at last inspection and update
The last rating for this service was Inadequate and published on 26 April 2023, with a supplementary report publishing enforcement action taken, on 23 August 2023. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
This service has been in Special Measures since 26 April 2023. During this inspection the provider demonstrated improvements that have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures. However, we found the provider remained in breach of some regulations.
Why we inspected
The inspection was prompted in part due to concerns received about people’s safety and care, and to check whether they were now meeting the legal requirements. A decision was made for us to inspect and examine those risks.
The inspection was also prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management and risk of falls. This inspection examined those risks.
We found no evidence during this inspection that people were at risk of harm from this concern.
Enforcement and Recommendations
We have identified breaches in relation to medicines management and risk management.
We have made 2 recommendations, in relation to safeguarding and end of life care.
Please see the action we have told the provider to take at the end of this report.
Follow Up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.