Primrose Neurological Centre

Primrose Neurological Centre is a residential care home for adults who have experienced a brain injury or have a neurological condition, which may include associated complex needs. The service can support up to 7 people in one adapted building. At the time of the inspection 4 people were living at the service.

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

Medicines were managed safely. Records reflected the help people need and audits identified when improvements were required. Recruitment procedures were followed to ensure staff were suitable to work with people who may be vulnerable. People were supported by staff who responded to their needs quickly.

People said they were happy at the service and they liked the staff. People were cared for in a clean environment by staff who were caring, competent and keen to improve the service provided. Risk assessments were carried out and staff could explain the reason for the assessments and how they followed them to help keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s rights were upheld, and people received health professional advice when this was needed. The manager and staff worked with other agencies to improve the service provided.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

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 27 August 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in July 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 in the areas of safe care and treatment, person – centred care, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them.

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. Therefore, the overall rating for the service has not changed.

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

Follow up

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

Primrose Neurological Centre is a specialist care home for adults who have experienced a brain injury or have a neurological condition, which may include associated complex needs. The service can support up to seven people. At the time of the inspection five people resided at the service.

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

There was a lack of direction and leadership in the service. There had been a turn-over of registered managers and periods when there had been no manager in post. A new manager had started the week after our inspection and along with a new operations manager, had produced an action plan to address our findings.

People were not always receiving consistent care and support that met their needs. People’s care plans and assessments were not clearly focused on achieving positive outcomes, such as goals and steps to become more independent. Some people were not sure of the purpose of their stay or what the next step would be.

Risk assessments were not written or routinely available to staff to advise them on how they should support people safely. We identified three areas of risk that we informed the operations manager about and these were addressed on the inspection.

Staff were not always available in sufficient numbers to take people out or to give them one to one time. Some people assessed as requiring support and supervision at all times did not consistently receive this support. This potentially placed people at risk.

Staff did not receive the training, support or supervision needed to meet the specialist needs of people in the service.

We have made a recommendation about staff recruitment.

Medicines were being safely managed for the majority of people. However, for one person who was self-medicating there were insufficient checks to ensure they were safe to do so.

People told us they had built trusting relationships with staff and we observed some positive interactions between staff and people in the service. They were treated with dignity and respect. Staff were knowledgeable about people's likes and dislikes.

People told us they enjoyed going out with relatives and staff when they were available. However, a number of people spoke of being bored and a lack of things to do in the service. Some people were spending long periods in their rooms.

People were not always offered variety in their diet and people said there was a limited choice at mealtimes.

People’s capacity to make decisions was not being carried out in enough detail, in particular the support people required with different types of decisions.

Where people had been supported to access to healthcare and specialist support from external professionals these people had made good progress.

Quality assurance systems were not robust and had not identified the failings found at the inspection.

The new manager had experience of both being a registered manager of a care service and of working with people with neurological conditions, including brain injury. External healthcare professionals spoke highly of the new manager. People in the service and staff were keen to be part of developing the service under the new leadership.

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

Rating at last inspection

The last rating for this service was good (published July 2016). Since this rating was awarded the registered provider of the service has changed (23/07/2018). We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection.

Enforcement

We have identified breaches in relation to protecting people from avoidable harm, failing to have robust governance systems, and failing to ensure there were enough competent and trained staff deployed at the service.

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