Primrose 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. At the last inspection we rated this key question good. At this inspection the rating has changed to requires improvement.This meant people’s needs were not always met.

We found the provider was in breach of the legal regulations relating good governance.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff did not always ensure care and support reflected people's individual needs, preferences and choices. Assessment processes were in place, however care records were not always complete, accurate or sufficiently personalised to guide staff in delivering individualised care. We found examples where care plans contained generic information, duplicated content and lacked clear guidance about how people wished to be supported. Care plans relating to mental health needs and some specific health conditions were not always in place or sufficiently detailed. We noted care records had been altered some weeks before the inspection to provide less information. The provider’s audits had not identified this discrepancy.

Some people, relatives and professionals told us care had not always reflected people's expressed wishes or changing needs. Complaints identified concerns regarding support with preferred routines, mealtime assistance, specialist equipment and maintaining independence. Reviews of complaints found care delivery was not always consistently implemented in line with agreed care plans or professional recommendations. The new manager was taking action to make improvements.

Staff worked with healthcare professionals, including GPs, district nurses, rapid response teams and community services. Records the provider supplied showed staff sought professional advice and had guidance for supporting people with complex health needs, including epilepsy, enteral feeding and changing physical health needs. Staff meeting records also showed learning had been shared about timely information sharing with visiting professionals and access to medicines during planned professional visits. However, this partnership working was not consistently effective. Visiting professionals reported staff did not always recognise or respond promptly when people’s physical health deteriorated and did not always seek appropriate medical care. People’s experience of continuity was mixed. A relative said staff acted quickly when their family member required hospital treatment, kept them informed and followed hospital guidance for their enteral feeding. However, other relatives described frequent changes of manager, staff sickness and turnover, which affected consistency. Relatives found the repeated management changes led to “inconsistency regarding how the home is run.” A relative described how their family member had moved rooms several times, including a move they had not been told about, which they felt caused disorientation. Although the new manager had begun strengthening communication, handovers and professional working arrangements, these improvements were recent and were not yet fully embedded or consistently reflected in people’s experience.

The provider did not always ensure people had access to information in ways they could understand and supported them to communicate their needs and preferences. People, relatives and partners did not always receive timely, accurate and accessible information about care and support. The provider sent in resident and relatives' meetings, which indicated people were given information about safeguarding, complaints, advocacy, activities and safety matters. Relatives' meeting minutes also reported management shared updates about service developments and refurbishment projects. However, relatives told us communication was inconsistent and some said they were not always informed about changes affecting their family members. Feedback highlighted concerns regarding room moves, leadership changes and communication about care arrangements. As a result, people and those important to them were not always supported with the information they needed to make informed decisions about their care.

The provider had systems in place to seek feedback from people, relatives and staff, however people were not always assured their views influenced decisions about their care or the running of the service. The provider sent in residents and relatives' meeting minutes, which showed a structured approach to gathering feedback, and records showed concerns raised about food, activities and environmental issues had resulted in changes being made. However, despite assertions made by the provider people and relatives felt they were not fully involved in decisions. Several people and relatives felt complaints or concerns had not always been listened to effectively.

People were generally able to access the care, treatment and support they needed. Risk assessments and support plans demonstrated efforts to support people to access the community, pursue personal interests and maintain independence safely. Staff took account of individual health needs and risk factors when planning support. However, some people told us staffing shortages affected their ability to access activities, community opportunities and aspects of daily life. The rehabilitation focus of the Bluebell unit was not consistently reflected in people's experiences and they were not being supported to maximise independent living skills.

People's experiences and outcomes were not consistently positive. Feedback from residents, relatives and visiting professionals showed variation in how people experienced care across the service. Whilst many people described staff as caring and supportive, others reported concerns about personal care, involvement in care decisions, consistency of support and responsiveness to concerns. Complaints reviews identified recurring themes relating to implementation of care plans, communication, food provision and ensuring people's individual needs were consistently met. Support was not always delivered in line with assessed needs or professional advice. The new manager was taking action to address these issues.

The provider did not always ensure people's future needs, wishes and aspirations were consistently identified, reviewed and planned for. Although assessments and care planning processes were in place, records were not always sufficiently detailed, accurate or person-centred to fully support future planning. Care records required further development to ensure they reflected people's long-term needs, preferences and changing circumstances. Some people told us they wanted greater involvement in decisions about their future and where they lived. We received feedback from people who remained uncertain about future arrangements or felt previous discussions about returning home had not progressed. Planning arrangements were inconsistently implemented and support planning consistently focused on what mattered most to people.