Primrose Hill Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 63 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always ensure people’s care and treatment were effective, as people’s needs were not consistently reviewed, recorded or updated. This meant staff did not always have clear and accurate information to support people’s care and communication needs.

We found care plans were not always regularly updated and at times contained conflicting information, for example in areas such as communication needs and behaviour support planning. Although a serious incident had occurred, the care plan reviewed at the time of inspection did not clearly reflect the specific risks or provide clear guidance to staff on how to manage these. This meant appropriate strategies and up‑to‑date information were not consistently available to staff, which may result in inconsistent care and outcomes for the person.

We sought staff feedback on their involvement in reviewing care plans. While one staff member confirmed care plans were discussed and read, another staff member told us, “I would say yes and no for reviewing care plans. There are aspects that I may not have input on.” This indicated that staff involvement in reviewing and updating care records was not always consistent.

However, we saw that initial assessments were carried out prior to people receiving care, and staff demonstrated an understanding of people’s needs in day‑to‑day practice. Following our feedback, records confirmed that care plans had been updated to address the concerns raised.

The provider did not always ensure people’s care and treatment were planned and delivered in line with current needs and best practice guidance.

For example, on the day of inspection, we observed a person being given the incorrect fluid consistency, which did not match their assessed needs as outlined in their care records and Speech and Language Therapy (SALT) guidance. This placed the person at risk of choking and aspiration.

In addition, during our review of records and discussions with staff, we found medicines were not always administered in line with prescribed instructions and best practice guidance. For example, guidance for one person stated their medicine must not be crushed, yet staff told us this medicine had been crushed before administration. This meant medicines were not always administered in line with current guidance and placed people at risk of receiving unsafe care.

However, we also observed some areas of good practice. Support for people requiring modified diets was generally provided in line with SALT recommendations, and these were regularly reviewed and seen in records. One staff member told us, “Some residents are on a soft diet, and this is clearly recorded on the system. The kitchen staff also label the food,” which ensured staff had clear information to provide safe and appropriate support.

The provider worked well across teams and services to support people.

Staff told us there were systems in place to support communication, including handovers and daily updates. Staff described working together as a team and said communication was generally good during shifts. One staff member told us, “The communication is good here.”

The registered manager told us they worked with external professionals, including GPs and community mental health services, to support people’s needs. This demonstrated there were systems in place to support partnership working and information sharing.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

We saw that healthcare professionals, including GPs, were involved in reviewing and supporting people’s health needs. This demonstrated that the service worked with external partners to promote people’s health and wellbeing.

Staff supported people to maintain their independence where possible. One staff member told us, “We encourage people to do things for themselves where they can, such as eating or personal care, as this helps maintain their independence.” Staff recognised this could have a positive impact on people’s wellbeing and engagement.

Relatives also told us they were kept informed about changes in people’s health and were involved in decisions about care when required. One relative said, “Staff keep me informed about any changes in (person’s name) health and involve me in decisions. They contacted me, for example, when the COVID vaccination was due.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

Care plans and risk assessments did not always reflect people’s current needs or outcomes. For example, in areas such as behaviour support planning and communication needs.

Which meant staff did not always have clear information to monitor people’s progress or respond to changes. Although some reviews were taking place, these had not identified the concerns found during the inspection.

However, staff described some positive outcomes for people. One staff member told us, “When I worked here last year, [person’s name] was hardly eating, but now she eats well and has gained weight. We just encourage little amounts.”

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

Relatives told us they were involved in decisions about care and treatment. One relative told us, “They always ask and inform me of what’s going on”.

Staff demonstrated an understanding of the importance of seeking consent before providing care and treatment. They were able to describe how they gained consent and supported people to make decisions. Training records confirmed that staff had received training in the Mental Capacity Act (MCA) and were able to apply this in practice. One staff member told us, “I always explain what I am doing and ask before I provide care or assist with food.”

Where people lacked the capacity to make specific decisions, mental capacity assessments had been completed in line with the Mental Capacity Act 2005 (MCA). Decisions made on behalf of people were documented and reflected the principles of the MCA, including acting in the person’s best interests.