The Priory Nursing and Residential Home

We found the following examples of good practice.

The home had been divided into zones with separate entrances and exits for staff. Staff remained working in the same zone to prevent the spread of infection. The provider had converted a building on the grounds of the home as a testing facility for staff and visitors.

Visitors were asked for evidence of vaccine and a negative lateral flow test on arrival where there was no exemption. The manager kept relatives up to date with any changes and people were receiving visits from their relatives in line with the current guidance.

We saw there were PPE stations throughout the service outside people’s rooms for staff to be able to change their PPE before entering each bedroom. We observed that staff wore PPE throughout our visit.

Individual risk assessments were in place for people and staff regarding any identified risk factors of COVID-19. Staff and people were regularly tested and had received COVID-19 vaccinations.

The Priory nursing and residential home is a care home providing nursing and personal care to a maximum of 37 people. At the time of the inspection, 37 people were using the service. Accommodation is provided in one adapted building.

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

People were protected from the risk of abuse because the provider’s systems ensured staff were suitable to work with people. People told us they felt safe and risks to people’s safety and well-being were assessed and monitored. There were sufficient numbers of staff to meet people’s needs in a safe way.

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; however the policies and systems in the service did not always support this practice. People said staff always asked for their consent before helping them.

People had their needs assessed and were supported by staff who had the skills and experience to meet their needs. Staff monitored people’s health and well-being and worked with other professionals to make sure they received the care and treatment they needed. People’s nutritional needs were met and everyone we spoke with was happy with the food and drinks provided.

People were supported by kind and caring staff who ensured they were involved in decisions about their care. People were treated with respect and their right to privacy was understood and respected by staff. People were supported to remain as independent as possible.

People received a service which met their needs and preferences. There were opportunities for social stimulation and people could see their friends and family whenever they wanted. People were treated as individuals and chose how they spent their time. People and their relatives felt confident and comfortable to discuss any concerns with staff. People could be confident that their wishes for end of life care would be respected by staff.

The home was well-led and there were systems in place to monitor and improve the quality of the service people received. Staff were well supported and motivated. This led to a happy and inclusive environment for people to live in. The service worked in partnership with other professionals and the local community to achieve good outcomes for people.

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. (Report published January 2019) and there was one breach of our 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 our regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

The Priory Nursing and Residential Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides accommodation and support with nursing and personal care to a maximum of 37 people. The home provides a service to older people and younger adults. Accommodation is arranged over two floors with a shaft lift giving access to the first floor. At the time of our inspection 29 people lived at the home.

Our last inspection of the service took place in August 2018 where the overall rating was inadequate. We found the provider was in breach of 10 regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was placed in special measures and we used our enforcement powers which required the provider to make improvements to the management and governance of the home by 26 October 2018. Immediately following the second day of our inspection we used our powers which required the provider to tell us the action they would take to mitigate risks to the health, safety and well-being of the people who used the service. Action plans received from the provider provided reassurances that action had been taken to ensure risks to people had been reduced.

Although some improvements were noted at this inspection, more time is needed to demonstrate that improvements have been embedded and can be sustained. The service will be rated as requires improvement so the provider will no longer be in special measures.

Since the last inspection, there had been a change in the sole director of the company who had employed two senior managers to oversee the management and governance of the home. A deputy clinical manager, who was employed by the third day of our inspection remained in post and was supported by the senior management team. The provider had submitted an application to register a manager with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had taken action to mitigate risks to people’s health, safety and well-being, however further improvements were needed to ensure people were protected by the provider’s procedures for the recruitment of staff. Improvements had been made to protect people who were at high risk of pressure damage to their skin. There were regular checks on pressure relieving equipment and mattress settings to ensure they remained appropriate. However, details were yet to be incorporated into people’s care plans. This was also the case for people who required regular monitoring to manage their diabetes. Significant work had been undertaken to address our concerns about risks posed by the environment. This included replacing carpets and floorings and repairing large pot holes in the drive and car parking area. The provider took action to ensure radiators in the main corridor of the home, which were very hot to touch, were covered. Infection control procedures had improved since our last inspection. The home was clean and fresh smelling. Staff used and disposed of single use equipment appropriately. There were some improvements in the provider’s procedures for the management and administration of medication. Accidents and incidents were investigated and responded to. Staff had been trained how to recognise and report any signs of abuse.

The provider had taken action to ensure staff had the skills, training, experience and knowledge to meet the needs of the people who lived at the home. People were supported to have choice and control over their lives and were supported in the least restrictive way possible. Since our last inspection the provider had taken action to ensure people were provided with information in a format which met their needs. Some signage had been put in place to assist people to orientate themselves around the home. People’s health care needs were monitored and understood by staff. Referrals to health care professionals were made in a timely manner and any advice or treatment was implemented. Action had been taken to ensure people received a diet which met their needs and preferences. Although there had not been any recent admissions to the home, records showed that people’s needs had been assessed before they moved to the home.

People were supported by staff who were kind and caring. Staff supported and interacted with people in an unhurried manner and there was a happy and relaxed atmosphere in the home. Staff understood the need to ensure people were treated with respect. People’s privacy was respected. Care records had been securely stored and staff now conducted handovers in a private room to ensure people’s privacy and confidentiality was not compromised. Some action had been taken to ensure staff had an understanding of people’s life history, hobbies and interests. People had their own bedrooms which they could personalise in accordance with their tastes and preferences.

The provider was in the process of reviewing people’s care plans with them and, where appropriate, their relative to ensure they reflected people’s needs and preferences. Care plans had been updated to reflect any recommendations from health or social care professionals. Action had been taken to ensure people had opportunities for social stimulation. Care plans were in the process of being reviewed to ensure they contained information about people’s wishes during their final days and following death. The provider had reviewed their procedures for handling and responding to complaints and people now felt confident their concerns would be taken seriously.

Improvements had been made to ensure the home had a management structure which would help to drive improvements. Staff were supported to carry out their role. People were provided with opportunities to express their views. Systems were being introduced to monitor the quality of the service people received and to identify any areas for improvement. The provider promoted an ethos of honesty, learning from mistakes and admitting when things had gone wrong. They had informed the Commission of significant events which had occurred in the home in accordance with their legal responsibilities.

The Priory Nursing and Residential Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The home provides accommodation and support with nursing and personal care to a maximum of 37 people. The home provides a service to older people and younger adults. Accommodation is arranged over two floors with a shaft lift giving access to the first floor.

Our last inspection of the service took place in March 2018 where the overall rating was good.

This inspection was prompted by concerns shared with us by the local authority safeguarding team and the clinical commission group (CCG).

At the time of our inspection there was a registered manager in post however they had been on extended leave since July 2018. We have since received an application from the registered manager to cancel their registration with us. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks were not always identified and there were no systems in place to mitigate risks to the health, safety and well-being of the people who lived at the home. People’s medicines were not managed or stored in a safe way. People were not fully protected from the risk of harm or abuse. People were not protected by the provider’s procedures for the prevention and control of infection. Environmental risks were not well managed or addressed in a timely manner. There were no systems in place to monitor accidents or make improvements when things went wrong. There were sufficient numbers of staff to meet people’s physical needs. The provider’s staff recruitment procedures helped to ensure staff were suitable to work with the people who lived at the home.

The provider’s systems did not ensure staff had the skills, training, knowledge or experience to meet the needs of the people who lived at the home. People’s rights were not respected. People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible. No reasonable adjustments had been made to support people who had a visual or hearing impairment. There were no effective procedures in place to monitor and meet people’s healthcare needs. People were not supported to eat well in accordance with their tastes and preferences. There was a lack of signage to assist people to orientate themselves around the home. An assessment of people’s needs was carried out before they moved to the home.

Staff were kind to the people who lived at the home however people’s dignity was not always respected. Staff did not have time to spend quality time with people. Staff did not have information about people’s social history or interests. People’s records were not securely stored and people’s confidentiality was not always respected.

People were not supported to be involved in the planning or review of the care they received. Care plans had not always been updated to reflect changes in the support people received. People had limited opportunities for social stimulation. People could not be confident that any complaints about the care and treatment they received would be responded to. Information about how to raise concerns had not been produced in an accessible format for people who had a visual or cognitive impairment. People could not be confident that their wishes during their final days and following death were respected.

Ineffective leadership in the home had impacted on the people who lived at the home and the staff team. The provider's quality assurance systems had failed to identify the significant concerns in the service and had been ineffective in driving improvements. The ethos of honesty, learning from mistakes and admitting when things had gone wrong was lacking. The provider had not met their legal responsibilities to inform the Care Quality Commission of significant events which had occurred in the home.

The overall rating for this service is 'Inadequate' and the service is therefore in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At our last inspection in January 2017 we found the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider’s systems for monitoring the quality and safety of the service was not effective in identifying and addressing the shortfalls we identified at our two previous inspections. These related to the safe management and administration of people’s medicines, staff deployment and supervision, the environment and storage of moving and handling equipment.

At this inspection we found the service was now meeting the requirements of Regulation 17 and together with other improvements, had resulted in an overall rating of good.

The Priory Nursing and Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation with nursing care for up to 37 people. Accommodation is arranged over two floors with a shaft lift providing access to the first and second floor.

At the time of the inspection there were 34 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe living at the home. The way in which staff were deployed meant people’s needs were met in a timely and unhurried manner. People’s medicines were now managed and administered in a safe way by staff who had been trained to carry out the task. Improvements to the environment meant risks to people were reduced. People were protected from the risk of harm or abuse because the provider had effective systems in place which were understood and followed by staff.

People continued to receive effective care. People were supported by staff who were trained and competent in their roles. People’s health care needs were monitored and met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported by kind and caring staff who took time to get to know people and what was important to them. Staff treated people with respect and respected their right to privacy. People lived in an environment which was welcoming and homely.

People were involved in planning and reviewing the care they received which helped to ensure people received a service which met their needs and preferences. There were daily activities for people which they could choose to join in with. Complaints were taken seriously and responded to. People’s religious and cultural needs were understood and met by staff.

There were improvements in the provider’s systems for monitoring the quality of service people received. People’s views were valued and any suggestions for improvement were responded to.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection carried out 28 January and 1 February 2016 we asked the provider to make improvements to how they managed risks, the deployment of staff, the application of the principles of the MCA and some required changes to the building. At this inspection we found the provider had taken action to make some of the improvements required, however there were some issues which had not been addressed.

People sometimes had to wait for their care and support as staff were not always deployed appropriately across the home. People did not always receive their medicines in a safe way and it was not always clear if people received their medicines as prescribed. People were supported by staff that had been safely recruited. People were safe; staff understood how to protect people from harm. People’s risks had been assessed and staff understood how to provide safe support to minimise the risk of harm. Accidents and incidents were documented and analysed to prevent them from re-occurring.

People received support from staff that were suitably skilled to meet their needs. Staff used their skills and knowledge about people to provide effective care and support. People were asked for their consent to care and support and staff followed the principles of the MCA. Peoples nutritional needs were understood by staff and people could make choices about the food. Peoples health needs were understood by staff and they were supported to monitor and maintain their health and wellbeing.

People were supported by staff that understood their needs and had good relationships with them. Staff were caring in their approach with people. People had support from staff to make choices about their care and support. People received support from staff that understood how to protect their privacy, dignity and independence and offered support in a respectful way.

People’s needs were assessed and reviewed and their needs and preferences were understood by staff. People were involved in all aspects of planning their care. People were able to follow their interests and staff made sure people had an opportunity to spend time talking each day. People understood how to make a complaint.

The provider had not taken action to make all the required improvements since the last inspection. Quality checks were in place; however these were not always identifying issues with the quality of the service and action had not always been taken to address the improvements. For example, with medicines and staffing. Staff were supported throughout their daily work, however there was no formal opportunity for them to raise any issues such as training requirements. People and their relative’s spoke highly of the service, they were happy with the care and support people received.

There was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding good governance. You can see what action we told the provider to take at the back of the full version of the report.

The Priory Nursing and Residential home is registered to provide accommodation for persons who require nursing or personal care to a maximum of 37 older people. There were 34 people living at the service when we carried out our inspection.

The service had two registered managers at the time of our inspection. One of these registered managers was not in post at the time of our inspection but had not requested to be removed from our register which means their details were still present on the provider’s registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People told us they felt safe at the service and that the staff treated them well. People did however tell us they had to wait for assistance from staff on some occasions. Staff could identify signs of abuse, knew when to escalate concerns but did not always know how. People told us they had their medicines at the times they needed them. We saw that most risks to people’s health were identified and assessed although we did find the environment presented some potential hazards to people.

People’s consent was not always sought and staff did not always understand people’s rights in respect of decision making. People told us that they had confidence in the ability of the staff that cared for them but we found some staff needed updates in core areas of skill and knowledge. People had a choice of food and drink and were supported by staff with their meals and beverages when needed. People’s health care needs were promoted when they were in poor health..

People told us staff were kind and caring. People said their privacy was promoted and staff gave people choice when they provided them with care and support. People had opportunities to be independent.

People were involved in the care and support they received and they said the care they received reflected their needs. People were able to follow their chosen interests and pastimes.

People we spoke with were satisfied with the service they received. People felt able to complain and were confident any issues they raised would be listened to and resolved. Systems were in place to capture and review people’s experiences, but systems to monitor risks to people were not always robust, and staff felt they lacked direction due to the lack of consistent clinical leadership. People said they could approach management and share their views. Not all staff were confident that they were well supported by management however.

We asked the service to provide us with an action plan demonstrating what they had done to address these issues of non-compliance. We received an action plan from the acting manager. This detailed the procedures put in place to address the concerns.

This inspection was to see what actions had been taken.

During this inspection we found that, these areas of concern had improved and the home was compliant with the regulations. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking to people who used the service, speaking with staff, a relative and from looking at records.

We found that improvements had been made to medication record keeping within the service so people received their medicines in a safe and effective manner.

People who used the service, their relatives or visitors completed a satisfaction survey. The acting manager told us that two people had returned the surveys. Overall their comments were positive. We saw that staff responded to requests and comments made by people.

We found sufficient evidence to indicate that the acting manager had begun to develop an effective quality assurance system within the service, so that people who used the service were not at immediate risk. However, this needs to be developed to ensure the service moves forward in order to sustain and work towards continuous improvement.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who were able to told us they felt safe living at The Priory nursing and residential home. Other people appeared relaxed and comfortable in the company of the staff and the other people they shared their home with. Staff understood how to safeguard the people they supported.

People were not protected against the risks associated with medicines because the provider did not have arrangements in place to manage them. Appropriate arrangements were not in place for the receipt of medicines into the care home.

Is the service effective?

People told us that someone from the home had visited them to assess their health, care and social needs prior to them moving into the home. People's health and care needs were assessed and people we spoke with told us they were involved in discussing their care and support. However this was not documented to show that they had been involved. Specialist equipment needs had been identified in care plans where required. Visiting relatives told us that the staff were “Very good” and “Can’t fault them”.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

People told us that there were not always enough staff available and that sometimes they had to wait a long time for their call bell to be answered. The provider had increased staffing levels the week before our inspection.

Is the service caring?

People were supported by staff who demonstrated a clear understanding of their needs. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were supported by staff that gave them choices and respected them. One person told us, “They do what I need and they let me do what I can such as my hair”.

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes. We saw people were treated with respect and dignity by staff on duty.

Is the service responsive?

We saw the home had been responsive to people's changing needs. The home worked with other agencies and services to make sure people received their care in a joined up way. Staff had developed close and positive working relationships with health and social care professionals such as the district nurse and doctor. This ensured they worked in people's best interests and were able to continue to meet people's changing needs.

We saw people enjoying carrying out tasks to help the staff. These included folding the linen. One person told us of a concern they had and that this had been acted on by the registered manager to their satisfaction.

Is the service well-led?

We found the service did not have an effective quality assurance system in place to regularly assess and monitor the quality of service that people received. We found shortfalls in care plan documents. For example, several signatures were missing in care documents we looked at. No audit of care plans could be shown to us that could have identified these issues. We did see audits of wheelchairs and hoists carried out by maintenance staff. This meant that people’s safety with regard to hoists and wheelchairs was being monitored regularly.

Staff were clear about their roles and responsibilities. They told us the registered manager operated an open door policy and always welcomed their suggestions for improvement. They told us they had raised concerns about staffing shortages. However it was only recently that the provider had increased staffing levels despite staff telling us this had been an issue for some time.

Systems were not in place to make sure that managers and staff learned from events such as accidents and incidents. For example although staff had reported an allegation of potential abuse the registered manager had not reported this into the safe guarding of vulnerable adults procedure.