St Thomas' Priory

Hawksyard Priory Nursing Home is a care home providing personal and nursing care to up to 106 people over three different floors. There was access to a church and gardens at the home. The home provides support to younger adults, older people and people with dementia, mental health needs and those with a physical disability. At the time of our inspection there were 29 people using the service.

People’s experience of using this service and what we found

There were numerous issues identified throughout this inspection which had not been identified. Staff were not always recruited safely. The risk of contractors working unaccompanied on site had not been considered. Some improvements had been made to medicines management, but we found further improvements were needed. Risks to people were not always assessed and risks were not always mitigated.

Checks had been made on the safety of the building. However, timely action had not always been taken to rectify issues. Despite this, people felt safe and other safeguarding referrals had been reported. Lessons were not always learned when things went wrong. The building needed refurbishment, but the provider was already working on this. People told us they felt well treated, but we observed instances when they were not always treated with respect. People were not always supported enough to partake in enough activities of their choice. People were not always fully supported with their communication needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this. However, there was not always clear evidence of involvement from people’s relatives in the decisions to administer medicines covertly.

Staff received training and support to be effective in their role, although some improvements were needed. There were enough staff to support people. People felt safe and liked the staff. Infection control measures were in place to keep people safe. People liked the food and had choices, in line with their needs. People were supported to access other health professionals and had their health needs assessed and monitored, when needed. People were supported to remain independent. People felt staff knew them well and care plans contained people’s preferences.

People and relatives told us they felt able to make a complaint if needed and the registered manager was aware of their responsibility in this area. People’s end of life wishes had been considered. Despite some issues, people, relatives, and staff told us the home had improved since the last inspection. There was positive feedback about the registered manager and deputy manager. There were meetings to engage with those involved with the service.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 10 January 2023) and there were breaches of regulation. The provider had a date to be compliant by and completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about staff recruitment. A decision was made for us to inspect and examine those risks. This inspection was also carried out to follow up on action we told the provider to take at the last inspection.

We have found evidence that the provider needs to make improvements. Please see the full report for details.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to staff recruitment, assessing and managing risks to people, supporting people in a respectful and dignified way and the oversight of the quality and safety of the service.

We have issued the provider with warning notices. We will check the provider is taking action to comply with the legal requirements set out in the warning notices.

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.

Hawksyard Priory Nursing Home is a nursing and residential home providing personal and nursing care to up to 106 people over three different floors. There is access to a church and gardens at the service. The service provides support to people with physical and emotional needs, some of whom are living with dementia. At the time of our inspection there were 29 people using the service over the ground and second floor.

People’s experience of using this service and what we found

People were not always supported to receive their topical creams as prescribed. People were not always supported to receive their medicines in the form of a transdermal patch safely. Staff did not ensure people's medicines were in stock to ensure people received these as they were prescribed.

Staff were not always ensuring they were providing support to people in line with their care planned risks and needs. People's care plans were not always up to date and reflective of their needs.

Staff training had not always been effective to ensure staff understood the principles of the Mental Capacity Act and safeguarding comprehensively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. We have made a recommendation about staff training and competency checks to ensure staff have a sufficient understanding following their training.

Quality assurance tools had not identified all of the concerns we found at this inspection. Where audits were in place and had identified the concerns, we found action had not always been taken in a timely way to address these concerns. Accidents and incidents were not always shared with the registered manager to enable lessons to be learnt where things had gone wrong.

People did not have to wait for their care during our inspection however we have made a recommendation based on feedback for the provider to review their staffing levels against people's needs and risks. People were supported by safely recruited staff. People were supported by staff in line with infection control guidance.

People's weights were monitored and people had access to healthcare professionals where they were required. The home was spacious, and people were able to personalise their rooms should they wish to. People's care plans contained details of their preferences.

People, relatives and staff knew how to raise concerns and felt that action would be taken where concerns had been raised. Improvements were being made to the quality and oversight tools at the service at the time of our inspection and the provider and registered manager worked with us to ensure areas of concern were addressed as part of our inspection and following our visit.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies in the service supported this practice.

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

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

Rating at last inspection and update

This service was registered with us on 10 October 2022 and this is the first inspection.

The last rating for the service under the previous provider was inadequate, published on 13 September 2022.

Why we inspected

We received concerns in relation to medicines management, staffing, the quality of care and treatment at the service and managerial oversight. As a result, we undertook a focused inspection to review the key questions safe, effective and well-led only. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to people's safe care and treatment and the oversight of the service. We issued a warning notice to advise what improvements were required and when these were to be made by.

The provider began acting on the concerns we found during our inspection. We will meet with the provider to discuss further action they will be taking.

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.