Primrose House

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect. At the last inspection we rated this key question good. At this inspection the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

We found the provider was in breach of the legal regulations relating risk management, and good governance.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff always treated people with kindness, compassion and dignity and promoted caring relationships between people and staff. People, relatives and inspectors consistently described staff as kind, caring and respectful. During observations, when staff were available they supported people in an unhurried way, took time to engage with them and demonstrated warmth and empathy in their interactions. One person told us, “The staff are helpful, aye,” while another said there was “nothing wrong with the staff, good people.” Relatives described staff as “wonderful, very down to earth, friendly” and said they treated people “like a friend rather than a patient.” Staff were observed sitting with people during meals, supporting them sensitively and offering reassurance and encouragement. Many relatives and residents spoke particularly positively about the deputy manager and staff who knew people well and understood their individual needs. However, a small number of people reported occasions when they did not feel listened to or respected and one inappropriate comment by a staff member was overheard during the assessment. Despite this, the overall evidence showed people were usually treated with kindness and compassion by staff.

Staff did not always treat people as individuals or ensure care consistently reflected their preferences, wishes and assessed needs. Staff generally knew people well and there was evidence of positive relationships and personalised care. Risk assessments and care records often reflected people's interests, preferences, communication needs and desired outcomes, and behaviour support plans demonstrated an understanding of individual triggers and support strategies. However, care plans were not always accurate, complete or sufficiently personalised to guide staff effectively. Complaints and feedback identified occasions when people's preferred routines, dietary preferences and care needs were not consistently followed. Some relatives told us communication about changes affecting their family members had not always been effective and concerns were raised about people being moved between rooms without appropriate consultation. A person said, “Staff treat me like a child, as if I don’t have a mind of my own,” and said they wanted greater involvement in decisions about their life. These concerns demonstrated that although person-centred approaches existed, people did not always experience care that consistently reflected their individual preferences and needs.

Staff did not always promote people’s independence, so people did not always know their rights or have choice and control over their care, treatment and wellbeing. Although risk assessments promoted positive risk-taking, community participation and the least restrictive approach, people did not consistently experience this in practice. People said staffing constraints limited their access to activities, the community and opportunities to develop independent living skills. People said staff did not take them to the shop, help them access the garden or support them to take part in activities they valued. The unit was intended to provide rehabilitation, but there was insufficient evidence that people were consistently supported to develop independent living skills. Action to introduce regular outings remained in progress. The resident meeting minutes the provider sent us showed some positive practice, including people influencing activities, food choices and refreshments, discussing self-administration of medicines and receiving information about advocacy and safeguarding. However, people told us they did not get asked their views and not all people were consulted about significant room or floor moves. This meant people were not consistently supported to make decisions or retain control over important aspects of their lives.

Staff did not always respond promptly or consistently to people's immediate needs. Some systems were in place to identify risks, monitor wellbeing and escalate concerns, and the audits the provider sent demonstrated examples of staff recognising deterioration and seeking support from healthcare professionals when required. However, these audits had not been available in the service. Feedback from people, relatives and professionals identified occasions when support was delayed or not delivered in line with assessed needs. Concerns included delays in responding to requests for assistance, inconsistent implementation of care plans, delays in acting on clinical recommendations and occasions when people did not receive timely support with mobility, toileting or healthcare needs. Complaints highlighted gaps between care planning and practice, and professionals reported staff had not always responded effectively when people's health deteriorated. A relative described concerns about care delays and another person reported waiting for support or equipment they needed. These findings showed that while staff often worked hard to meet people's needs, responses were not always timely or consistently effective.

The provider did not always ensure staff felt supported, valued and enabled to provide consistently high-quality care. Staff described positive relationships with colleagues and spoke highly of the deputy manager, who was consistently described as approachable, supportive and focused on people's wellbeing. The staff meeting minutes the provider sent demonstrated an ongoing commitment to learning, training, incident review and safeguarding responsibilities. However, there was evidence of low morale associated with previous leadership arrangements, a high turnover of staff and reliance on agency workers. Staff reported they had not felt listened to or supported by previous managers and supervision had not always been provided regularly. Relatives also raised concerns regarding staffing continuity and the impact this had on consistency of care. Although improvements had begun following changes in leadership, workforce wellbeing and support arrangements had not always been effective, which impacted on staff experience and the consistency of care provided.