Primrose Hill Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed

This service scored 59 (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 had some systems in place to support a positive culture; however, these were not always effective or embedded in practice. Systems to support learning and improvement were not consistently effective in driving sustained change. For example, following a serious incident, records had been reviewed and updated; however, we were not assured that identified risks were consistently reflected across records or that guidance for staff was sufficiently clear and embedded in practice. Staff were also not always aware of measures the registered manager told us had been introduced to reduce those risks, including one-to-one support.

Concerns identified during the inspection, including issues in medicines management and gaps in care planning, had not been identified or addressed through the provider’s own monitoring systems. This further demonstrated that opportunities to learn and improve were sometimes missed and that improvements were not embedded to reduce the likelihood of recurrence.

However, there was some evidence of reflective practice. Incidents were reviewed by management and discussed with staff, and staff told us they received feedback through team meetings and handovers. One staff member said, “We always have a briefing to explain what happened and what could’ve been done differently.”This would usually be done the same day or the day after.”

The provider had systems in place to work with people and healthcare partners to support safe care. However, these were not always effective. They did not always ensure people’s safety was monitored or that care was consistently coordinated, particularly when people’s needs changed.

Care plans and risk assessments did not always reflect people’s current needs, and important information was not always clearly recorded or updated. For example, where a person’s skin integrity plan had changed, this was not always clearly detailed to reflect current care and what had been updated. In addition, we found staff were not fully aware of arrangements in place to manage risks, despite the registered manager informing us that one-to-one support had been implemented. This demonstrated that information about risk management was not always effectively communicated or consistently understood by staff.

As a result, we could not be fully assured that staff had access to up-to-date guidance to support safe and consistent decision-making, which may impact the safe delivery of care.

However, the provider had systems in place to assess people’s needs prior to admission. The registered manager told us that pre-admission and face-to-face assessments were completed, which included reviewing people’s clinical needs, behavioural support and any dietary requirements, to determine whether the service could meet those needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People generally felt safe living within the home and around staff. One person told us, “I feel staff know what they are doing”. The provider had systems in place to safeguard people from abuse and harm. Staff demonstrated an understanding of safeguarding procedures and were able to describe how they would report concerns. There was evidence that safeguarding incidents were reported and reviewed by management.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found no concerns and Deprivation of Liberty Safeguards (DoLS) were in place for people when needed.

The provider did not always work effectively with people to understand and manage risks. Staff did not always provide care that was consistently safe or enabled people to feel secure.

Feedback from people about how risks were managed was mixed. One person told us, “Staff know what they are doing.” However, another person told us they did not feel safe due to other people entering their room.

Some care plans and risk assessments did not always reflect people’s current needs, which meant staff did not always have access to accurate information to support them to manage risks safely and consistently. "For example, following a serious incident, records reviewed at the time of inspection did not always clearly reflect the identified risks or provide consistent guidance for staff on how those risks should be managed."

This meant people were not always supported in a way that enabled risks to be managed safely and consistently in line with their needs.

However, we found some examples of appropriate risk assessments that had been regularly reviewed, including those relating to people’s Speech and Language Therapy (SALT) guidance.

The provider did not always detect and control potential risks in the care environment.

Environmental risks were not always promptly identified or effectively managed. During the inspection, we identified hazards within a bathroom and a poorly maintained outdoor area.

While some outdoor risks had been recognised, necessary improvements had not been fully completed, and concerns remained at the time of inspection. These included uneven paving and loose bricks in the garden, which could present a trip hazard.

While some environmental risks had been identified and actions were underway, environmental concerns remained at the time of inspection. We raised these environmental risks with the manager during the inspection. Some improvements were completed on the day, including cleaning However, other risks remained in progress at the time of inspection. We will check this on our next visit.

However, staff demonstrated an understanding of the importance of maintaining safety within the environment and were aware of how to respond if equipment was not working. One staff member told us, “We know what to do if equipment isn’t operational. We would raise this with the nurse and ensure there is a replacement or alternative in place.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

One person told us, “I watch them with other people, and they are very good with them.”

The provider had systems in place to ensure there were enough staff to meet people’s needs. During the inspection, we observed that staffing levels were sufficient. Staff were able to support people with their care needs and respond to requests for assistance promptly. One staff member told us, “It’s improved a lot in the past couple of months. In more recent times there is enough staff.”

Staff had completed relevant training and spoke positively about the learning opportunities provided. Records showed that a system was in place to monitor staff development and ensure required training was kept up to date.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed that infection prevention and control practices were in place, and areas of the environment were visibly clean. Staff demonstrated awareness of safe hygiene practices. One staff member told us, “I use aprons and gloves as part of my PPE. This keeps both of us safe [resident and staff].”

There was sufficient personal protective equipment (PPE) available across the home, including gloves, aprons and masks. Handwashing and hand sanitiser facilities were also available to help reduce the risk of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The providers systems to ensure people’s medicines were administered safely were not effective. Covert medication was not always managed in line with best practice.

Although covert authorisations were current, they were not consistently followed. For instance, we observed a tablet being added to a person’s drink after they had refused it, which did not align with their agreed covert plan. Guidance for another person stated a medicine must not be crushed, yet staff told us they had been crushing it. This raised concerns that medicines were not always administered according to prescribed instructions.

We also found some PRN medicines protocols did not provide sufficiently detailed guidance to support staff in determining when PRN medicines should be administered and what interventions should be attempted before administration. Whilst the provider has subsequently submitted evidence of protocols containing references to least restrictive practice, the guidance available during the inspection did not provide sufficient assurance that staff had clear and consistent information to support decision-making and best practice.

However, staff told us they had received training to administer medicines, and their competency was assessed to ensure they were able to do so safely. People and relatives spoke positively about how medicines were managed. One person told us, “They give them to me and I take them.”

The provider was responsive to our feedback and told us they had taken action to address the concerns identified. We will review whether these improvements have been embedded and sustained at the next inspection.