Archived: Primrose Court Care Home

Primrose Court Care Home is a care home that was providing personal care to 15 older people and people living with a dementia at the time of the inspection. It can provide care for up to 20 people. The home is an adapted building, providing care over two floors.

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

Risks to people were not actively managed and recommendations from health professionals were not consistently followed. The quality of record keeping needed to be improved and staff had not received up to date training. People and relatives were happy with the care provided. One relative said, “The home is smashing. The staff are smashing. I am happy with everything.”

The overall quality of the home had deteriorated. There was a lack of effective management and oversight of the home. Checks to monitor the quality of the home had not led to improvements. Staff were committed to the home and said they felt part of a team who could rely on one another.

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 25 June 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had not been made and the provider was still in breach of regulations. This service has been rated requires improvement for the last four consecutive inspections. At this inspection, it has now been rated inadequate.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 8 May 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. In addition, we also followed up on concerns which we received in relation to the care of people living at the home, staffing and oversight of the home.

This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Primrose court care home on our website at www.cqc.org.uk.

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the care which people receive and how the risk of harm is managed. We also identified breaches in how people are safeguarded from the risks of potential abuse; the competency of staff to deliver safe care and the procedures in place to oversee the home.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

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.

People’s experience of using this service: We identified two ongoing breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014, in relation to the premises and equipment cleanliness, a lack of notifications to CQC and ineffective quality assurance processes.

Medicines were managed. Risks to people were assessed and action was taken to address them. Staffing levels were safe and the provider had robust recruitment processes.

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. Staff received regular training, supervision and appraisal.

People received kind and caring support. Staff treated people with dignity and respect. Relatives spoke positively about the service.

Staff provided person-centred care. People were supported to access activities they enjoyed. The provider had an effective complaints process.

Feedback was sought and acted on. The service had formed community links that benefited people living there.

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

Rating at last inspection: Requires improvement (Report published June 2018). This service has been rated requires improvement in the last three inspections.

Why we inspected: This was a planned inspection. It was scheduled based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Primrose Court Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Primrose Court Care Home accommodates 20 people with residential care needs across two floors. On the day of our inspection there were 14 people using the service.

The home had a registered manager in place. A registered manager is a person who has registered with CQC 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.

Primrose Court Care Home was last inspected by CQC on 8 February 2017 and was rated Requires Improvement overall and in two areas; safe and well-led. We informed the provider they were in breach of Regulation 12: safe care and treatment and Regulation 18: staffing. The risks to people from unexpected incidents such as fire were not managed in a safe manner and there were insufficient staff on duty overnight to meet the needs of the people who used the service.

Whilst completing this inspection we reviewed the actions the provider had taken to address the above breaches. We found the provider had ensured improvements were made to meet the above regulations. However at this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is therefore the second consecutive time the service has been rated Requires Improvement.

The provider did not have effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were not always carried out.

The provider had audits in place to measure the quality of the service however some of the audits had failed to successfully identify the deficits we found in the service.

The home was clean, spacious and suitable for the people who used the service.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities about safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe management and administration of medicines.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people who used the service.

Staff were supported to provide care to people who used the service through a range of mandatory and specialised training, supervision and appraisal. Staff said they felt supported by the registered manager.

People who used the service and their relatives were complimentary about the standard of care at Primrose Court Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Care records showed people’s needs were assessed before they started using the service and care plans were written in a person centred way and were reviewed regularly. Person centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs.

People had access to healthcare services and received ongoing healthcare support.

Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the home and within the local community.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint.

People who used the service, relatives and staff were regularly consulted about the quality of the service through meetings and surveys.

You can see what action we told the provider to take at the back of the full version of the report.

We inspected the home in October 2015 and found there were gaps in staff training and supervision; the care records needed to be accurate and up to date; medication administration arrangements needed to be enhanced; and the performance management and audit systems needed to be improved. We found that the home was breaching regulation 9 (Person-centred care), regulation12 (Safe care and treatment), regulation 17 (Good Governance) and regulation 18 (Staffing). We rated Primrose Court Care Home as ‘Requires improvement’ overall and in four domains.

Primrose Court is registered to provide residential care and support for up to 20 older people some of whom maybe living with dementia. Each person has their own private bedroom and access to shared communal areas. At the time of the inspection 16 people used the service.

The home has had a registered manager in place since the home registered in August 2015. 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.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the home.

At this inspection we found the action the registered manager had been taken had made significant improvements to the way the home was run. The team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

During the inspection we found that there were insufficient staff on duty, particularly overnight. All of the 16 people who used the service needed the support of at least one member of staff and a quarter of the people needed two staff to assist them. During the night two staff were on duty and we were informed that this had been the case for many years. The registered manager told us that no dependency tool was used to calculate the staffing levels and no consideration had been given to the peoples’ gradual increased dependency.

We saw that fire precautions, procedures and the fire risk assessment needed to be improved. The fire procedures referred to one staff member guiding people to the fire point and taking charge of making sure all were accounted for whilst the other staff assisted people to leave the building. Overnight with only two staff on duty it would be impossible to adhere to this procedure. We also noted in the last eighteen months no night staff had completed fire drills. When we discussed what action they would need to take in the event of a fire the night staff did not realise they were to support people to evacuate the home.

During the day a senior and two care staff were on duty. We noted that the home had accessed apprenticeship schemes and two apprentices were on duty. The staff we spoke with included the apprentices in the numbers of staff on duty and treated them as full member of the team. From our discussions with the registered manager we found that the apprentices were to be supervised when completing any personal care tasks. However we could find no system in place to identify which staff member was allocated to supervise each apprentice. Also there was no mechanism in place to support and verify the learning the apprentices completed each shift.

We found that overall the administration and management of medication was in line with people's prescriptions. However staff needed to enhance the procedures for checking and booking in quantities of bottled medication and medication that were received outside of the monthly delivery.

People told us they were happy with the service and felt the staff did a good job. People felt the registered manager was approachable.

People’s care plans were tailored for them as individuals and created with them and their family’s involvement. People were cared for by staff that knew them really well and understood how to support them. We observed that staff had developed very positive relationships with the people who used the service. The interactions between people and staff were jovial and supportive. Staff respected people’s privacy and dignity.

Safeguarding and whistleblowing procedures were in place to protect people from the types of abuse that can occur in care settings. The registered provider’s recruitment processes minimised the risk of unsuitable staff being employed.

Staff received mandatory training in a number of areas, which assisted them to support people effectively, and were supported with regular supervisions and appraisals.

Where people had difficulty making decisions we saw that staff worked with them to work out what they felt was best. Staff understood the requirements of the Mental Capacity Act 2005 and had appropriately requested Deprivation of Liberty Safeguard (DoLS) authorisations.

People told us they were offered plenty to eat and we observed staff assist individuals to have sufficient healthy food and drinks to ensure that their nutritional needs were met. People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health.

The registered manager understood the complaints process and detailed how they would investigate any concerns. The registered manager took on board the issues raised in complaints so for example had improved the care records by introducing a one-page summary sheet, as a family member pointed out this could readily assist staff to understand people’s needs.

The registered manager was committed and passionate about the people they supported and were constantly looking for ways to improve.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the registered provider to take at the back of the full version of the report.