Priors House

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

This is the first inspection for this service under this newly registered provider. This key question has been rated outstanding. This meant services were tailored to meet the needs of individuals and delivered to ensure flexibility, choice and continuity of care.

This service scored 89 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider was exceptional at making sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs.

The provider used a recognised model for dementia care to identify what was fundamental to people’s emotional and psychological wellbeing. Staff explained how they used information to understand people’s responses and motivations so they could provide care in the most person-centred way possible. For example, staff shared 1 person often became anxious during the evening and sometimes expressed this anxiety by physically responding to staff. Staff explained addressing the person by using a specific endearing term was effective in reducing their anxiety and de-escalating situations. Staff described how referring to another person by their former professional title assisted in reducing behaviour this person could display that could be unsettling for other people.

Staff told us how knowing people could help them respond appropriately when people were low in mood. For example, 1 staff member spoke of a person who could become frustrated by their health condition. They explained, “We have a lady who has [health condition] who is always happy, so when she is out of character, we take her somewhere quiet, and she will get to vent, and she says she feels better now.” Another staff member told us of a person who had improved their mobility with physiotherapy input and staff support. They commented, “[Name] came very quiet and reserved, I think they lost who they were for a little while, but the day after they came, they started the physio and it has improved their mental wellbeing. It is nice to see we can bring someone back to how they were previously."

Relatives told us how staff used their knowledge of people to motivate and engage them. One relative told us, “They know [Name] likes singing so they make sure they go to anything to do with singing which they absolutely love. They (staff) are very good at realising what their residents like and very good at making sure they get to do things.” Another relative said, “I think they bend over backwards to do the best they can and they look after [Name] very well. They try to make it as personal as possible.”

People told us being able to personalise their bedrooms was encouraged and important to them. Two people particularly appreciated they were able to be surrounded by many of their personal mementoes in what they recognised would be the final residence of their lives. One of those people told us, “I will live here for the rest of my life, and I am happy that I have got all my own pictures on my walls.”

People’s care was reviewed regularly with them and their relatives by key staff, including the chef and the lifestyle lead through the ‘Resident of the Day’ programme. This ensured people remained at the centre of their care and changes in any aspect of their daily lives was captured and planned for.

The provider always understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

People received continuity of care from a consistent staff team who had time to learn about people and understand their individual needs. One relative told us, “Unfortunately [Name] has lost her words now, but she would talk to the staff and they’re always the same ones in her wing. There may be 1 or 2 new ones, but always the same core unit so there’s never any strangers and always staff who know the residents. I think the continuity is excellent.”

Managers and staff worked effectively with external health professionals from the pre-admission assessment through everyday care provision to end of life care. One health professional told us, "I have a really good relationship with them. I think they provide a really good standard of care."

Some staff had received extra training from external healthcare professionals so they could provide a link to that specific specialism and promote integrated care. For example, 1 staff member had completed extra training with the Speech and Language Therapy Team (SALT) around eating and drinking risks. The registered manager explained, "The staff will come to her and say they are worried about someone swallowing and she will give some advice and then ring it through to the SALT team. It is someone who can give that intermediary advice because she has done the training."

Where people wanted to maintain their own GPs, healthcare professionals or service providers, this was facilitated where possible. One person told us they appreciated the fact their own hairdresser of over 50 years was able to attend the home to style their hair. Another relative told us their family member continued to attend their familiar community day centre and was escorted there by staff.

Where people’s health declined and they needed to move to a different suite within the home for dementia care, this transition was considered and managed gradually to ensure continuity of care. A member of staff explained, “It is done over a 2-week period, they will go down each day and have a meal and do an activity. If they are settled after 3 or 4 days, we will increase the stays to 2 or 3 hours, and they won’t move until we think they are ready. We try and replicate exactly how they have their bedroom upstairs to their bedroom downstairs, so everything is familiar to them."

Staff were respectful of family relationships and where relatives wanted to maintain an active caring role in their family member’s life, staff worked with them to make it happen. One relative told us, “I try to go virtually every afternoon so I’m constantly there but if there’s anything out of hours, they ring me, so yes, they’re very on the ball with that regard.” Another relative described the collaborative approach to decision making on behalf of their family member and told us, “A lot of the time I will ask for their advice as well. [Name] has ongoing dental issues, and we have a domiciliary team come out to her. They’ll discuss what they think, and I’ll look to the nurse for what is in [Name’s] best interests. It’s a high level of trust.”

The registered manager was proactive in ensuring people had the appropriate funding in place to ensure continuity in their care provision. One relative described their difficulties in securing funding for their family member and said, “[Registered manager] knew my difficulties and she was amazing."

The provider supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

People’s sensory needs were assessed to ensure they had all the appropriate aids in place to support effective communication. For example, spectacles and hearing aids. Where a need was identified, staff used visual aids such as show plates for those people who needed to see what they were being offered to eat and drink. Alternate aids to support written communication such as Braille and large print were available when required. Some people were supported to use electronic devices to maintain important contact with families and friends.

The provider was exceptional in providing opportunities for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff involved people in decisions about their care and told them what had changed as a result.

The provider encouraged people to share feedback and take an active interest in the management and direction of the service. People met with the registered manager every 2 weeks to share their views and experiences. Feedback was used to identify areas of improvement and actions taken to improve people’s outcomes. For example, following comments by people, improvements had been made to the hearing loop system so people could hear more clearly in busier areas of the home. The structure of mealtimes had been altered in response to people’s feedback which had a positive impact on appetite and nutritional intake.

Relatives told us they were involved in regular reviews of their family member’s care. One relative said, “It’s so nice to have a place that actually listens to what you’ve got to say, they recognise that you know them (people) and what happens.” Another relative commented, “I review her care plan every 6 months although I never have any issues because they take good care of her.”

Relatives described a collaborative approach to addressing any concerns or issues they raised. One relative told us, “If I’m not happy, they’re not defensive, we work out possible solutions together, that gives me a lot of reassurance. I can talk to the staff and I’m comfortable talking to them about any issues.” Another relative commented, “If I am concerned, I mention it to the lead people in the wing, and it’s taken care of straight away. There’s never been something I’ve had to escalate, it’s always been acted on if there’s anything I feel is not right.”

People and relatives were invited to attend meetings and share their views of the home through regular satisfaction surveys. The latest survey demonstrated relatives had rated good communication as a key area of strength within the home. Information had been shared about the actions taken to address those areas where relatives had suggested improvements could be made.

The complaints process was available to people and visitors to the home. Complaints were managed in accordance with the provider’s complaints process and used as a tool for improvement. One staff member told us, “They (management) don’t shove complaints under the carpet. They are dealt with quickly, so they don’t repeat themselves. If there is a complaint it could mean a resident wasn’t getting the best care and that is not good enough for us at Priors.”

Informal concerns were also recorded so the registered manager could identify any patterns or emerging issues.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

People had access to a range of health and social care professionals, services and equipment to maintain their health, wellbeing and independence. This included doctors, dentists, opticians and physiotherapists. Where a need was identified, people were signposted to independent advocates to ensure they had access to all the support and treatment options available to them. An independent advocate supports people to understand their rights, explore their choices and express their wishes to healthcare professionals and other agencies involved in their care.

The home was purpose built and accommodated people’s accessibility needs. Clear signage and personalised memory boxes outside bedrooms supported those people with cognitive impairment to orientate themselves around the home.

Overall, outside spaces were well planned and gave people, whatever their mobility needs, a space to enjoy fresh air and physical exercise. However, on the first day of our inspection, we found people in the dementia community did not have the same unlimited access to an outside space thereby reducing their opportunities to make choices about how and where they spent their time. The registered manager assured us this would be addressed with staff to ensure consistency and equity in access for all.

A minibus enabled outings and activities, so people had opportunities to access the wider community.

Staff and leaders were innovative in how they listened to information about people who are most likely to experience inequality in experience or outcomes. Staff and leaders actively used this information to provide exceptionally tailored care, support and treatment in response to this.

Staff understood the inequalities people could face due to their age, disability or cognitive impairment. Staff told us they respected people for who they were and were confident to challenge discrimination or oversight. One staff member told us, “I am always really aware of the residents, making sure how they are doing and checking whether there is anything they need. We are all very aware of noticing and being conscious and making sure residents get the care they need." Another staff member explained, “Their conditions doesn’t define them, they all have their own character and background, and they are their own people. If that was my family member, how would I like them to be seen. They were a person before they came into care and they are still that same person coming into care."

There was an inclusive and open approach to supporting people to develop meaningful relationships without discrimination or barriers. Where people with dementia demonstrated an interest in developing new relationships, managers worked with people, their relatives, dementia specialists, social workers and staff to ensure this happened in a safe and positive way with appropriate management strategies everyone was comfortable with. A staff member explained, “Just because they have dementia does not mean they don’t have the right to the same opportunities as everyone else in Priors House. People tend to look at the condition, but they don't look at the person as a whole.”

Staff were aware of those people who were either physically unable to engage in activities or did not benefit from or enjoy group events. These people's bedrooms were designated 'Sunflower' rooms and staff were encouraged to spend time with these people. Some staff were trained in Namaste which is a sensory based programme designed for people living with advanced dementia or approaching the end of their life. One relative told us, “The lifestyles team that do the activities go into her room and do Namaste and hand massages.” Another relative said, "I think they are fantastic, they really try with [Name]. She likes her own company, but they will try to get her out. [Staff member] was able to massage [Name’s] hands and she let [staff member] do that the other week. Although she is reluctant, they never give up."

People’s cultural and religious needs were identified, respected, and met, ensuring these important aspects of identity were fully supported. Priors House held church services and supported visits from local religious representatives. One person told us, “The priest in charge can come and visit me here and friends I had from church can come in here and we can have a nice natter.” A relative confirmed, “[Name] does go to the church there and I find that reassuring. She’d stopped when she was at home as she couldn’t get there, it was too much effort, whereas here it’s much easier to access.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

Relatives expressed reassurance by the sympathetic approach demonstrated by staff when discussing issues related to their family member’s end of life care. One relative told us, “The staff have been very open with [Name] and with me. I know [staff member] has had good conversations with [Name] about that. It’s quite nice as obviously sometimes there are things [Name] won’t talk to me about. She’s been very good with [Name] about this and equally good talking to me.” Another relative said their family member had previously been very unwell but their health had gradually improved. They told us, “They’re very sensitive to the family’s needs. They would feed me and I could be there any time I wanted. When it (end of life) does happen, I’ve got every trust in them. I’ve been on site before when people have passed away and they make sure that doors are closed and they are always acting with dignity and respect.”

Staff understood their role in supporting people and their relatives during the final stages of life. One staff member told us, “Their last few days should be calm and peaceful. We will do an end-of-life care plan, it could be certain music they want on, they may want family around them, they may want photos around them. Whatever they want at their end of life we will do." Another staff member said, “When we lose a resident, it is a sad time, the loss is doubled because we lose their family as well and we have built those relationships.”

The home had facilitated discharges from hospital for end-of-life care to enable people to have a private and dignified death in a caring environment. The provider’s information return (PIR) expressed the feeling of privilege in ensuring people and their families could spend quality time at the end of their life. Where people or their families had chosen to share information about people’s end stage of life wishes, these were documented in their care records.