Priory Mews Care Home Also known as 1-3366549077

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.

Priory Mews Care Home is registered to provide personal and nursing care to up to 156 people. At the time of the inspection 112 people were living at the service. Priory Mews Care Home is purpose built and arranged across five 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 using this service and what we found

People were not protected from harm. Staff did not always recognise what constituted abuse. Individual risks were not always assessed appropriately, and safe measures were not in place to manage and mitigate risk. Medicines were not managed safely. Incidents were not always reported to enable close monitoring and learning lessons to achieve better outcomes.

Although agency staff were used to cover shortfalls in staffing levels, staff were not sufficiently deployed across the service to ensure people’s needs were met. Safe and robust recruitment practices were not followed.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People’s needs were not always assessed accurately or kept up to date to make sure people received safe and appropriate care. Staff supporting people received training but did not always put this onto practice, so people’s safety was compromised. Healthcare advice was not always followed, putting people at risk of deterioration in their health. People were happy with the choice of food, but some people were not supported to eat their meal in a safe or comfortable way.

The environment was poor in some areas. Some bathrooms were cluttered and unclean with items in easy reach that could be unsafe for people walking around. The service was not clean in all areas and some doors were broken and therefore a hazard.

People were not supported to maintain their privacy and dignity. People were calling out and staff were not attending to them quickly to provide reassurance. Many people were cared for in bed without evidence of a valid reason.

Some people were not supported in a person-centred way with their individual needs and wishes driving their care. Some people were not supported to have a meaningful day that prevented social isolation. Complaints were not always reported or logged in order to monitor and learn lessons.

The provider had taken over the service on 30 August 2022 and told us they were working hard to make improvements, including refurbishing people’s living environment, staff recruitment, staff training, creating a positive staff culture and to increase meaningful activity. However, we saw poor care, relatives told us about poor care and parts of the living environment were not safe or pleasant to live in. Most of our concerns had not been identified and recognised by the provider or registered manager through monitoring and auditing processes.

Information was not always accessible and people’s communication needs were not always met, to make sure people understood. We have made a recommendation about this.

We had better feedback from relatives of people living in some units than others.

People could have visitors at any time without restriction.

People had end of life care plans in place. The provider and registered manager had held meetings with people, relatives and staff since taking over the service. The provider had also undertaken satisfaction surveys with people, relatives and staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us as a new provider on 30 August 2022 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 27 January 2021.

Why we inspected

The inspection was prompted due to concerns received about people’s safety, dignity and respect, staffing and management and leadership. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding vulnerable adults, management of risk and learning lessons, medicines management, staffing, recruitment, people’s rights under the MCA, person centred care, dignity and respect, complaints and management and leadership at this inspection. We have made a recommendation about accessible information and communication.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report for some of the identified breaches.

Follow up

We will request an action plan as well as meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

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.