Archived: Primrose Care Home

At the last inspection on 9 and 18 February 2016, the service was rated Good. At this inspection we found the service remained Good.

At the last inspection we asked the provider to make improvements to care plans. We found this action had been completed. Care plans were personalised and provided information about the care each person required. They had also been evaluated to help keep them up to date. People’s needs had been assessed.

Improvements had been made to falls monitoring and other audits were being completed.

During this inspection we found the provider did not have a process for reviewing food and fluid charts. We have made a recommendation about this. Care plan audit records were not available during the inspection.

The home had a registered manager. People, relatives and care workers gave us positive feedback about the registered manager.

People and relatives said they received good care. They told us care workers were kind, considerate and treated them with dignity and respect.

People, relatives and care workers confirmed the home was a safe place to live. Care workers understood the importance of safeguarding people and knew how to use the whistle blowing procedure if required. Care workers confirmed they had not needed to use the procedure previously. Medicines were managed appropriately.

There were enough care workers on duty to meet people’s needs. Some relatives told us they felt night time staffing levels were insufficient. We carried out an out of hours inspection check on the staffing levels. We found care workers were usually able to meet people’s needs quickly. Care workers told us night time staffing levels were fine and the registered manager sought their views regularly. Health and safety checks were carried out regularly.

Care workers told us they received good support and had completed the training they needed. Records confirmed supervisions, appraisals and essential training were up to date. People were supported to meet their nutritional needs and to access the healthcare they needed.

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 service supported this practice.

People had opportunities to participate in activities. These included outings to the garden centre, shopping, Beamish Museum and the beach. Where people chose not to take part their decision was respected.

Regular residents’ meetings took place and people had been consulted to gather their views about the home.

People and relatives told us they knew how to complain but did not have any concerns. One complaint had been received which had been fully investigated and resolved.

Further information is in the detailed findings below.

Primrose Care Home provides residential accommodation and personal care for up to 22 older people. At the time of our inspection there were 17 people living in the home.

The home had 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered provider had breached regulation 12 of the Health and Social Care Act 2008. This was because people’s care plans had not been kept up to date following changes in their needs and to reflect their current circumstances.

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

People and family members gave us only positive feedback about the care provided at the home. One person told us, “I get looked after. We have carers here to look after you.” People were treated with dignity and respect by kind and caring staff who knew their needs well. One person said, “The staff are very good to me.” Another person said, “Staff couldn’t be any better. All the staff will do anything for you, nothing is a problem.”

People said they were safe living at the home. One person told us, “I am quite safe, the doors are all locked. I am champion in here.”

Staff had a good understanding of safeguarding adults and knew about the registered provider’s whistle blowing procedure. Staff said they would have no hesitation to report any concerns they had to the registered manager. One senior staff member said, “Staff would definitely raise concerns, I have no doubt everyone would raise the alarm.”

Medicines records supported the safe administration of medicines. Medicines administration records (MARs) had been completed accurately and medicines were stored securely.

People told us staff were always available to tend to their needs in a timely manner. One person told us, “I only have to ring that buzzer and they [staff] are there. If they are busy they make time for you.” Staff commenced their employment only after all recruitment checks had been concluded satisfactorily.

A range of health and safety checks were carried out to help keep the premises safe, such as checks of fire safety, emergency lighting, moving and assisting equipment, gas safety and electrical safety. The home’s business continuity plan needed updating as some information was out of date. Incidents and accidents were investigated to ensure action was taken to help keep people safe.

Staff told us they were well supported to carry out their role and received the training they needed. One staff member said, “Good, I feel well supported. If I have ever had problems I always felt I could go to [registered manager] with problems. If I have any issues I can air them.”

The registered provider followed the requirements of the Mental Capacity Act 2005 (MCA), including the Deprivation of Liberty Safeguards (DoLS). DOLS authorisations were in place for people requiring an authorisation and staff had a good understanding of MCA.

People were asked for their consent before receiving care. One person commented, “They [staff] ask you what you want.”

Staff had clear guidance about the individual strategies to be used when people displayed behaviours that challenged. This included distraction techniques, such as talking to people, offering a cup of tea and quiet time.

People were supported to meet their nutritional needs. We saw people received the support they needed to eat and drink. One person said, “The food is alright, you get plenty to eat in here. Another person said, “The food is marvellous. I get a good feed in here.”

Adaptations had been made to the home to improve the care for people living with dementia, such as clear signage, different coloured doors with photos and ‘life histories.’ The activity co-ordinator was proactive in identifying meaningful activities for people living with dementia. One family member said, “The activity co-ordinator is really good. She has some really good ideas. The community gets involved with them.” Three staff were doing advanced dementia training.

People had regular input from a range of healthcare care professionals, such as GPs, dietitians and speech and language therapists.

People’s needs were assessed before and after admission to the home which included gathering information about their life history and preferences.

People and family members we spoke with did not raise concerns with us during our inspection. One person said, “I cannot fault them.” There were opportunities for people and family members to give their views, through meetings and questionnaires.

Regular audits were carried out to help ensure people received good care, including checks of the catering service, domestic services, a medicines audit and a falls audit.

We saw the care plans about each person's needs were detailed. We saw care plans were more frequently reviewed so they showed people's current well-being and whether there had been any changes.

We also looked at people's care following concerning information we received about how people's mobility needs were being met and whether people were supported to maintain their dignity. We saw that one person's mobility was deteriorating and their ability to stand could change from day to day. This meant staff now needed to always use lifting equipment for this person.

We found people were dressed appropriately and were well cared for in a homely environment. Staff respected people's choices about how they wanted to spend their day.

Visiting relatives made many positive comments about the care at the home. They told us, 'It's homely and friendly. The care is brilliant.'

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. If you want to see the evidence that supports our summary please read the full report.

Is the service caring?

People were supported by calm and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. We saw people were assisted at their own pace. Staff spent time chatting with people in a warm and engaging manner.

People who were able to express a view told us they were 'well looked after'. One person told us, 'It's very good. The lasses are very kind.' Another person commented, 'I've been here a long time and I'm very satisfied with it.'

One relative said, 'I think the care is very good. All the staff have a lovely attitude.' Another person told us, 'You can tell the staff genuinely care about people. It's not just a job to them.'

A visiting care professional told us, 'The staff seem friendly and the care is adequate.'

In discussions staff were knowledgeable about people's diverse needs and respectful of their individual preferences. Our observations of the care provided and discussions with people showed us that individual wishes for care and support were taken into account.

Is the service responsive?

Relatives told us they were confident that staff responded to people's individual needs and choices. One person commented, 'It's always the same staff which is really good because they know everyone really well and can spot even tiny changes in how they are.' Another person told us, 'It's small and like a family. There's good continuity of staff so they know everyone's ways.'

People and visitors told us there were occasional trips out to local shops which helped to keep people involved with their local community.

People and visitors told us they could approach the manager at any time if they wanted to discuss anything and felt they were listened to. One visitor told us, 'All the staff are approachable and I would feel able to raise any issues with the manager.'

Is the service safe?

People told us they felt 'safe' at the home. People described staff as 'kind', 'friendly' and 'patient'. One relative commented, 'Staff are very nice and people seem happy being here.'

We looked at the staff rotas which showed that there was sufficient care staff on duty to meet people's needs throughout the day. There was a visible staff presence in this small home so that staff could support and supervise people when needed. People's requests for assistance were responded to promptly so people got support in a timely way.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager understood the home's responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager had previously contacted the local authority for advice about a DoLS authorisation for one person. The manager was aware of a recent court ruling regarding DoLS in care settings, and was awaiting further guidance from the local authority about how the revised definitions of deprivation of liberty might impact on people living in this home.

Is the service effective?

People and their relatives felt the home supported people's individually preferred lifestyles. One person told us, 'I like that I can sit where I want and do what I want to do.'

Relatives commented that the home had acted on changes in people's needs. For example the home arranged for one person who declined to take medication to receive their medicines in liquid form which they now accepted.

People had an individual care plan which set out their care needs. Some people's care records were not always reviewed in a timely way to make sure they were up to date. This meant some records did not accurately reflect people's current needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The home had a registered manager. People and their visitors told us they had 'confidence' in the management of the home and that 'the manager gets things done'. Staff told us they felt 'supported' and 'well managed'.

The provider had a system to assure the quality of the service they provided. The way the service was run had been regularly reviewed.

People and their visitors confirmed that they were asked for their views about the service. We saw that satisfaction questionnaires were given to a sample of people or their relatives each month. We looked at the responses for the past four months and saw these were positive about all aspects of the service.

We saw that staff supported people in a sensitive and engaging way and regular activities were arranged. People who we were able to speak with told us they were happy with the quality of their care, and told us they felt happy in the home. One person told us 'I am very happy. I have everything I need'. A visitor told us 'My mother is much happier here'.

We saw that assessments of needs were used to plan the support that people needed and care plans were updated when a change of care was required.

The service had a recruitment and selection procedure in place and carried out relevant checks when recruiting staff. The home also had systems in place to regularly check the quality of care and other services and residents and relatives were regularly consulted for their views about their care and treatment.

During our inspection we observed that enough staff were present to provide care for all of the people living at Primrose Care Home. Staff attended to peoples needs promptly and interacted with them appropriately.