Primrose Court Nursing Home

Primrose court nursing home is a care home providing residential and nursing care for up to 54 young adults and older people living with a mental health condition, dementia, physical disability or sensory impairment. Accommodation is across two floors, each of which has separate adapted facilities. The ground floor specialises in providing care to people who have a mental health condition. At the time of our inspection there were 46 people using the service.

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

Improvements had been made across the service since the last inspection. People said they felt safe and were happy living at the service. There were enough staff on duty who knew people well. We have made recommendations about the systems in place to manage distress and agitation and the safe management of medicines.

Staff were supported to carry out their roles safely, working in-line with national guidance to care for people with long term conditions. The environment had been well-thought out for people living with dementia; improvement plans for the mental health unit were in place to further support people’s well-being needs. People spoke highly about the meal support they received. We have made a recommendation the provider reviews the mealtime experiences for people living with a dementia.

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.

Staff were kind, caring and compassionate in their approach with people. They encouraged and supported people to live fulfilled lives. Care was dignified and staff respected peoples wishes and preferences. They were supported to maintain contact with loved ones. A diverse culture was in place.

People received individualised care and support from staff who knew them well which supported them to be as independent as they wished to be. Care records needed continued development to ensure they were truly person-centred. People had opportunities each day to be involved in social activities and had access to transport to enjoy days out. We made a recommendation in relation to end of life care.

The provider had made significant improvements to the service since the last inspection. Quality assurance systems were effective in leading change and incorporated feedback from people, relatives, staff and health professionals. Leaders were visible and staff were proud to work at the service delivering care which improved people’s lives.

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 8 September 2022) and there were breaches of regulation. We issued two warning notices. The provider also 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also received concerns in relation to the leadership and management of the service, the environment, risk management, dignity and respect, quality of care and staff conduct and training.

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.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Recommendations

We have made recommendations in relation to the management of medicines, the systems in place to oversee the management of agitation and distress and the mealtime experience for people living with dementia.

Follow up

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

Primrose Court Nursing Home is a residential care home providing personal and nursing care to up to 54 people. The service provides support to people living with dementia and people who have a mental health condition. Accommodation is across two floors, each of which has separate adapted facilities. The ground floor wing specialises in providing care to people who have a mental health condition. At the time of our inspection there were 46 people using the service.

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

Medicines were not managed safely. People were exposed to risk of harm due to a lack of person-centred risk assessments. Infection control was not always effectively managed in the home. Accidents and incidents were analysed but not every incident was correctly recorded so lessons were not always learnt. Safeguarding incidents were reported, and investigations were carried out correctly. Staff were recruited safely. There were enough staff to provide care and support to people.

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

We found that blanket restrictions on people’s freedoms were in place. For example, people were not allowed to go out after 8pm. The environment needed refurbishment. Some furniture and signage was damaged. The first floor was not decorated in a dementia friendly way. Staff had completed training, but we did not always see this in practice, for example around medicines management and infection control procedures. People were provided with enough food and drinks and told us they enjoyed them.

People were not always treated with dignity and respect. We observed some very positive interactions between staff and people using the service, however, we also saw some staff failed to engage with people at all or did so in a disrespectful way. People were given choices around some aspects of their care and asked for feedback on a regular basis.

People did not have opportunity to take part in activities they enjoyed. There was very little going on in the home and people told us they were bored. Care plans did not always accurately reflect peoples care needs or preferences. People’s communication needs were not always met and people with hearing or sight loss had a mixed experience of care. Complaints were reviewed in line with the provider’s policy.

Quality checks of the service had not identified all of the issues we found. We found a number of areas where records were not fully completed, accurate or up to date. Staff told us morale was good and they felt well supported by management. The registered manager understood the importance of sharing information when things went wrong. Staff had opportunity to raise concerns at staff meetings. Staff, people who used the service and their relatives were asked for their feedback via surveys and meetings. Negative comments were noted, and an action plan had been put in place, although not all actions had yet been completed. Most of the relatives we spoke with told us communication was good and they felt able to approach the manager or staff if they had any concerns.

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 4 September 2020).

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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider arranged more specific training for staff in subjects like challenging behaviour and mental health. At this inspection we found the provider had made improvements in this area.

Why we inspected

The inspection was prompted in part due to concerns received about cleanliness of the home, accurate record keeping and interactions between people using the service and staff. A decision was made for us to inspect and examine those risks.

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 have found evidence that the provider needs to make improvements. Please see the full report for further details.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment including medicines management, person-centred care, the home environment and good governance.

We have made recommendations about supporting people to make choices at mealtimes and accessing additional training for staff.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 Court Nursing Home is a residential care home providing personal and nursing care to 32 people aged 65 and over at the time of the inspection.

The care home accommodates 54 people in three separate wings. One wing for hospital discharge, short stay/rehabilitation beds, one for people living with dementia and one for people who have a mental health condition.

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

The service had failed to maintain accurate and complete records in respect of people’s care and support. Individual risks were not always identified, and some care plans had not been updated when people’s needs changed. Medicines were not managed safely. Only nine staff out of 45 had completed a fire drill. Quality assurance systems were completed however the audits had not highlighted the concerns we raised

People were protected from abuse by staff who understood how to identify and report any concerns. Staffing levels enabled people’s needs to be met safely. The registered manager sought to learn from any accidents and incidents involving people.

As part of CQC’s response to the coronavirus pandemic we are also conducting a thematic review of infection control and prevention measures in care homes. The Safe domain also therefore contains information around assurances we gained from the registered manager regarding infection control and prevention.

Staff were recruited safely. Records to evidence staff had received training were not up to date. Due to COVID19 obtaining training for new staff had been difficult

We have made a recommendation about training.

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 home supported this practice. People were happy with the food provided. People were happy with their rooms and had personalised them.

Staff were caring and treated people with kindness and respect. People's independence was encouraged..

Care plans needed to be more person centred. One person did not have a full care plan in place. People were confident to raise any concerns they had with staff. Staff were trying their best to keep activities going during COVID. People were provided with information in a way they understood. Peoples end of life wishes and preferences needed to be recorded.

People and staff felt supported by the registered manager and provider.

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

This service was registered with us on 23 August 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about, risks to people’s safety, medicines, infection control, staff training and the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified two breaches in relation to keeping people safe and the leadership of the service at this inspection.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.