We carried out a review of the data available to us about Primrose House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Primrose House, you can give feedback on this service.
Primrose House is a residential care home. The service was providing personal care for five people at the time of inspection who were living with a learning disability or/and autism.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
People’s experience of using this service:
The service worked in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.
People using the service received planned person-centred care and support that is appropriate and inclusive for them. People received a service that was safe, effective, caring, responsive and well led.
Systems were in place to keep people safe. People’s needs were met by suitable numbers of staff who knew them well. People received their medicines as prescribed and were protected from the risk of infection.
People were involved in meal planning and were supported to assist with cooking. People were treated with kindness and respect and staff spoke fondly about them. People’s privacy and dignity were respected, and they received personalised care which was responsive to their individual needs.
People enjoyed a range of activities which they chose to do. People had support plans in place which covered a range of information about their social histories, preferences and support needs. The provider sought feedback from people and their families to improve the service.
Rating at last inspection:
At the last inspection the service was rated Good (17 November 2016).
Why we inspected:
This was a planned inspection to check that this service remained Good.
Follow up:
We did not identify any concerns at this inspection. We will therefore re-inspect this service within our published timeframe for services rated good. We will continue to monitor the service through the information we receive.
Primrose House provides accommodation and personal care for up to six people with learning disabilities. At the time of the inspection five people were using the service.
The service had a registered manager in post. 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.
People felt safe and protected from harm. People's safety was promoted as risks that may cause them harm in their home and in the local community had been identified and managed. Appropriate risk assessments were in place to keep people safe.
Staff understood what constituted abuse and took action when people were at risk of harm. Robust recruitment and selection procedures were in place to make sure suitable staff worked with people who use the service.
Medicines were managed safely. All staff had received training in the safe management of medicines. The provider had systems in place to store medicines.
There were enough qualified and skilled staff at the service. Staffing numbers and shifts were managed to suit people's needs so that people received their care when they needed and wanted it. The provider’s training was designed to meet the needs of people using the service. As a result, staff had the knowledge they required to care for people effectively.
There were policies and procedures in place in relation to the Mental Capacity Act (MCA) 2005. Staff were trained in the principles of the MCA and could describe how people were supported to make decisions; and where people did not have the capacity, decisions were made in their best interests.
People were supported to have a healthy diet dependent on their assessed individual needs. People had a choice of foods and were involved in preparing their own meals where possible.
People had access to a range of health professionals and staff supported people to attend appointments when necessary.
Care plans were informative and contained clear guidance for staff. They included information about people’s routines, personal histories, preferences and any situations which might cause them anxiety or stress. The plans clearly described how staff were supposed to support people in these circumstances. Adapted easy-to-read versions of the care plans were made available to people to facilitate their involvement in the care planning process.
The provider promoted people’s personal interests and hobbies. Social activities were organised in line with people’s personal interests and there was a lively atmosphere at the service. The service maintained strong links with the local community.
People who use the service the staff were very complimentary about the registered manager of the service. People told us that they were accessible and approachable. A positive and open culture was promoted at the service. The provider had effective systems in place to review the quality of the service provided.
The inspection took place on 1 and 2 September 2015 and was unannounced. Primrose House provides residential accommodation and care for up to six people with learning disabilities, including people with autistic spectrum disorder. At the time of our inspection three people were living in the home, as two people were away on holiday.
The home is a two storey building, with a double hand-railed stairway providing access between floors. People had access to an enclosed secure garden.
The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
Record keeping was not always accurate, as information did not always reflect people’s daily experience appropriately. Information was not always cross referenced between records to ensure staff were aware when people should be monitored to review changes in their health or support needs. There was a risk that trends may not be identified to ensure that any changes required to people’s care were addressed promptly. The provider’s annual house audit and development plan were not sufficiently robust to monitor the quality of care people experienced, or to identify and drive improvements required.
Risk assessments did not always reflect current staff guidance to manage specific risks that may affect people. However, staff communication ensured that this did not place people at risk of harm, because staff understood the actions required to promote people’s safety.
Appropriate recruitment procedures ensured people were supported safely by staff suitable to provide their care, although the provider’s recruitment policy did not reflect all the regulatory requirements. We have made a recommendation that the provider reviews their recruitment policy to ensure it documents all the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) 2014.
People were protected from the risk of abuse, because staff understood how to support people when they were in a vulnerable position. Staff were able to recognise signs and indicators of abuse, and understood the requirement and process to report concerns.
Equipment in the home was checked and serviced in accordance with manufacturers’ guidance and the provider’s procedures. Regular fire drills ensured staff understood and followed fire safety procedures.
Staffing levels were sufficient to ensure people were supported safely. The staff roster provided flexibility to support people to attend planned appointments and meetings.
People were protected from risks associated with medicine administration, because staff were trained and competent in administering their medicines. Records demonstrated that people received their prescribed medicines at the correct time, and medicines were stored and disposed of safely.
Staff had sufficient training to meet people’s identified needs effectively. The registered manager and deputy manager worked with staff, and so were able to assess staff competency, and provide additional and refresher training to ensure staff demonstrated the skills required. Staff supervisory and general meetings provided opportunities to discuss issues and aspirational wishes. The registered manager used information from these meetings to direct training or guidance to ensure staff developed and maintained the skills required to support people effectively.
People’s decisions were respected by staff. Staff explained the consequences of decisions to people where this could affect their wellbeing, but followed people’s wishes and sought their consent to the care provided. Staff supported people in accordance with the Mental Capacity Act 2005, and understood when it was appropriate to follow the process of mental capacity assessment and best interest decision-making.
People were supported to maintain a nutritious and balanced diet. Staff were aware of risks associated with eating, and ensured people were not at risk of harm due to eating habits or types of food offered.
People were supported to attend planned health appointments. Staff understood when people’s anxieties meant they may not be compliant with health interventions. They supported people to understand the importance of health reviews and appointments, and proactively supported people to confront their anxieties to promote their health and wellbeing.
People were supported in a caring and kindly manner by staff. Staff took delight and pride in people’s achievements, and encouraged their independence and talents. People were involved in discussions about their care, and supported to maintain cultural and spiritual traditions that were important to them. Staff respected people’s privacy, and took appropriate steps to maintain their dignity.
Staff identified changes to people’s needs and moods, and requested investigation by and guidance from health providers as necessary. Communication between staff ensured people received their planned care in accordance with professionals’ instruction.
People were supported to attend a range of activities in the local community, such as college, a day centre and swimming baths. Outings provided opportunities for people to relax together, for example with trips to the seaside. People were able to relax at home and entertain themselves with games, music or quiet time alone as they wished. Staff discussed activity options with people to ensure they participated in activities they enjoyed.
People and their relatives were involved in planning and reviewing people’s care needs, and records reflected people’s individual needs and wishes. Opportunities were provided for formal and informal feedback or complaints through meetings, questionnaires and the provider’s complaints procedure. The registered manager reviewed this feedback to inform actions to address any issues raised.
The registered manager was respected and appreciated by staff and relatives, as they guided staff to care for people effectively and led by example. Staff demonstrated the provider’s values such as respecting people’s rights, and supporting people to achieve life skills and work towards independence.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.