Primrose Hill Nursing Home

Primrose Hill is a nursing home providing personal and nursing care for to up to 50 people. The service provides support to people living with dementia, mental health needs and those with a

physical disability. At the time of our inspection there were 46 people using the service.

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

Governance systems did not consistently ensure people always had access to their prescribed medicines and records were always completed. Medicines were stored and administered safely, and we saw the issues identified had not impacted on people.

People were safeguarded from abuse by staff that understood how to recognise the signs and take action to protect people. Where people had risks to their safety, these were assessed, and plans put in place to reduce the risks. Infection prevention control measures were in place at the home and staff understood and followed these. Where incidents occurred, people had a review of relevant risk assessments and plans to prevent recurrence and incidents were monitored to look for themes and trends.

Staff were recruited safely and given an induction and training to support them in their role. There were sufficient staff to meet people’s needs and the registered manager reviewed this using a dependency tool to ensure safe staffing levels were consistently available.

People had their needs assessed and care plans were put in place to meet those needs. Staff were given any updates about people’s needs daily in regular handover meetings. People had a choice of food and drinks and any risks relating to nutrition and hydration were assessed and planned for.

People had access to support with their health needs and plans were in place to give guidance for staff on how to support them effectively.

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.

Care plan audits were in place to ensure they were accurate and up to date. There were systems in place to learn from complaints, safeguarding and other incidents to ensure improvements were made. Feedback was sought from people, relatives, and other visitors to the home to check on the quality of the care people received. The provider worked in partnership with other organisations to seek support for people living in the home.

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 (9 May 2023).

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.

The last rating for this service was requires improvement (published 9 May 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

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 COVID-19 and other infection outbreaks effectively.

We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern, however some improvements were needed. .

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Primrose Hill Nursing Home is a residential care home providing personal and nursing care to up to 50 people. The service provides support to people living with dementia, mental health needs and those with a physical disability. At the time of our inspection there were 44 people using the service.

Primrose Hill accommodates people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Risks for potentially restrictive aspects of people’s care had not always been considered or assessed. We found door gates were used in several areas of the home and people’s capacity to consent to their use had not been fully considered.

Assessments of people’s capacity to make specific decisions had limited detail and did not contain information to reflect how staff had made the decision that people lacked capacity.

Systems used to assess the quality of care people received were not always effective in identifying areas which required review or improvement. Staff told us senior managers, acting on behalf of the provider, had not always spoken to them in a respectful way. Feedback received from local agencies reflected they experienced delays when requesting information relating to incidents and events.

People told us they felt safe. Staff were able to identify signs of potential abuse and knew how to escalate concerns for people’s safety. With the exception of the use of door gates, risks had been assessed and staff knew how to support people safely. People received their medicines as prescribed and there were enough staff to support people. Staff had been safely recruited. People were supported by staff who were following infection control guidance.

Staff had received training to equip them in their role. People’s needs were assessed, giving consideration to their individual needs. People received support with their food and drink in accordance with their assessed needs and preferences. The home environment was suitable for the needs of people living at the home. People received support to manage their health needs and staff contacted outside healthcare agencies to ensure people’s needs were met.

Despite concerns from staff about the way they had been treated by people in senior management roles, feedback about the registered manager and the home management team was positive. People, relatives and staff felt able to share their views with the management team and staff felt supported in their role. There was evidence of learning from incidents and events.

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 requires improvement (published 4 June 2020).

Why we inspected

The inspection was prompted in part due to concerns received about people’s health needs not being met. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective section of this full report.

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 COVID-19 and other infection outbreaks effectively.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to consent and the governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Primrose Hill Nursing Home Nursing Home provides personal and nursing care for up to 50 younger or older adults who have a variety of needs due to their mental health, physical disability, or sensory impairment. There was 30 people living at the home on the first day of our inspection.

Primrose Hill Nursing Home which was built for purpose has three units across three floors, At the time of our inspection the ground floor was in use as a dementia care unit. The first floor was a nursing unit with the third floor in use as staff training and accommodation.

The inspection was conducted over three separate days. The third day of the inspection was prompted by concerns received about a safeguarding alert that was initially raised by the provider. A decision was made for us to inspect and focus on interviewing staff and to look at their support, and how there would not be a repeat of these risks. This incident is subject to a possible criminal investigation. As a result, this inspection did not examine the circumstances of the incident, but we did consider the provider’s initial responses and how these would ensure people’s safety. We found no evidence during this inspection that any people were at an ongoing risk of serious harm from this concern. The provider had taken steps to reduce the risk to people following learning from this incident and was making some significant changes to improve people’s safety that were in the process of implementation on the last day of our inspection.

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

The service had not had a consistent manager on site to provide leadership at the home since it was first registered, and home manager had only been appointed a few months before. People's feedback about the new manager was positive and the wider senior management team were open and honest about the improvements that were needed. This included better leadership, more consistency with staffing, improvement in record keeping and care planning and better risk assessment. Quality monitoring systems were being developed but there was further improvement needed so these were more effective. Work on these systems was underway during the inspection.

People's care plans and risk assessments did not always reflect people’s needs and preferences although staff demonstrated an awareness of people’s needs, likes and dislikes. Staff were able to explain, or we observed them provide appropriate, safe care that reflected people’s needs and preferences.

People were not consistently safe although staff had a good awareness of what to do to minimise risks of harm or injury to people as far as possible without infringing their rights. There were occasions though where documentation to ensure staff were well informed of all potential risks to people was not fully completed.

Most people were satisfied with how their medicines were managed, but there had been occasions where systems had not ensured people’s medicines had always been available. Further consultation with stakeholders and other health care providers was needed to avoid any repeat of these incidents.

There was enough staff available to keep people safe and staffing levels were reviewed and changed to reflect changes in people’s needs, although reliance on agency staff to maintain staffing levels had impacted on the consistency, and safety of care at times. The provider was committed to stopping the use of agency staff for these reasons and was recruiting staff and limiting admissions to ensure this was achievable.

People were supported by care staff who had the skills and knowledge to meet their needs. People expressed confidence in staff skills and knowledge and staff understood, felt confident and well supported in their role. People's health was supported as staff worked with health care providers, whether on or off site, as needed to support people’s healthcare needs.

People were supported to have choice and control of their lives and staff understood they should support them in the least restrictive way possible; the policies and systems in the service supported this practice, although their consent to restrictions was not always recorded.

People had access to food and drink, with most people enjoying their meals, and the service offered specialist or culturally appropriate diets when needed.

People were supported by care staff that overall were caring and expressed interest in people and the support they provided them. This had not been consistent though with some occasions where people had not received a caring or safe response from staff. Staff were knowledgeable about people, their needs and preferences and used this to develop good relationships with the people. People’s privacy, dignity and independence was respected by staff.

We saw the service was responsive to information from people and relatives. People could complain, and concerns were listened and responded to by the staff. Complaints and comments were recognised as a useful tool to drive improvement of the service.

People, relatives and staff were able to share their views and where people were involved in planning their care, although there was not always a clear record of this process. People said they enjoyed living at Primrose Hill Nursing Home and said their care usually reflected their needs and preferences. People were able to follow their chosen routines and had access to a range of activities.

People said the manager and staff were approachable, listened and responded to them and acted on feedback when they shared this with them.

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

Rating at last inspection

This service was registered with us on 24 January 2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of the provider’s initial registration.

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.