Archived: Priory Paddocks Nursing Home

Priory Paddocks Nursing Home is a nursing home providing personal and nursing care to 30 people at the time of the inspection, some people were living with dementia. The service can support up to 40 people in one adapted building.

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

The provider had a good history of meeting standards and regulations, however, since our last inspection there had been a deterioration in the service and standards of care provided to people.

We were not provided with all the information requested during our inspection. No records relating to the governance systems and health and safety were received. Therefore, we could not be assured that the provider and registered manager’s oversight and systems to monitor the service to identify and address shortfalls were either in place or robust.

Incidents of abuse had not always been reported to the local authority who were responsible for investigating concerns of abuse.

We were not assured there were effective systems to keep people safe from harm. Risks in people’s daily lives and in the care environment were not always being assessed and there was a lack of written guidance provided to staff in how any risks were to be mitigated. We saw no evidence or received any information which demonstrated learning from incidents, and monitoring and analysis of incidents and accidents.

People’s care plans were not person centred and did not detail the needs people required to meet their specific requirements. Records relating to the care provided to people were not always complete and accurate. This was a risk of people receiving unsafe and inappropriate care.

There had been no staff training or care staff meetings since the start of the pandemic. This meant new and existing staff were not being provided with support and guidance to keep people safe and provide good quality care.

The registered manager told us about the issues they had with recruiting new staff. The provider had taken the decision to not admit any new people into the service until the staffing levels had increased. We were not assured that people’s emotional and social needs were always being met, due to the staff being busy supporting people with their personal care needs.

Medicines were being stored safely and nursing staff were able to explain the systems in place to ensure people received their medicines when they needed them. However, not all medicine administration records showed people received their medicines as prescribed.

The registered manager and staff were proud that no one using the service had contracted COVID-19. However, we found infection control processes were not robust. There were systems to support people to have visitors and a programme to test staff and people using the service.

We were told by staff about some taps, baths and showers not working in the service. Staff were, at times, transporting hot water in bowls and buckets to support people to bath and/or wash, which was not safe.

We received feedback that the call bell system to alert staff if a person needed help worked intermittently and could not be heard throughout the building. This was a risk that people may not receive the care and support they needed in a timely way.

Despite our findings we received positive feedback from people using the service, relatives and two health care professionals. All feedback received commented on the caring nature of the staff.

Feedback from staff demonstrated they were committed to providing people with good care, but were concerned about the lack of training and staffing levels. Staff were complimentary about the registered manager and their caring nature, however, some staff told us there was a lack of leadership and they did not feel listened to or supported to raise concerns about the service to the registered manager.

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 good (published 13 November 2018).

Why we inspected

We received concerns in relation to the management of the service, the safety of people using the service and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The inspection was prompted in part by intelligence received of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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 improvement. Please see the safe 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 Priory Paddocks Nursing Home on our website at www.cqc.org.uk.

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 breaches in relation to safe care and treatment, safeguarding people from abuse, the provision of staff training, and the systems to monitor the service, at this inspection.

Please see the action we have told the provider to take at the end of this report. We have added conditions to the provider's registration, these conditions ask the provider to undertake actions to provide assurances of improvement and safety. Please see the enforcement action we have taken at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. 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 with the 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Priory Paddocks Nursing Home is a home providing personal care to 26 people at the time of the inspection, some people were living with dementia. The service can support up to 40 people in one adapted building.

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

There had been some improvements made since our last inspection in October 2021. However, these were either being planned and/or not fully implemented or embedded in practice to demonstrate people were provided with a safe and well-led service at all times.

Since our last inspection, the registered manager, who is also one of the providers, had taken the decision to not work in the service since the beginning of January 2022. They had also submitted an application to cancel their registered manager registration. The deputy manager had left the service. In December 2021, the provider had sourced the support from a consultant to assist to drive improvement in the service.

The supporting home manager, who was an existing staff member who had taken on some management duties, and consultant were working to improve the service. There was a management structure in place in their absence, including on call support for out of hours.

There had been little improvement in the training provision for staff. Since our last inspection, staff had received fire safety training and some staff had received moving and handling and safeguarding training. The consultant told us they had identified training companies to provide both face to face and eLearning for staff. At the time of our inspection these companies had not yet provided any training.

There had been some improvement in people’s care plans and risk assessments. There were one-page profiles and ‘this is me’ documents completed which provided staff with a summary of people’s needs. Staff were working on the care plans in addition to their usual roles in providing care. A staff member told us three people’s care plans and risk assessments had been reviewed and rewritten, to guide staff in how their needs were to be met.

Incidents of abuse were now being reported, as required. Systems were being introduced to improve the ways staff recognise and report abuse. A system was in the process of being developed to learn from incidents, and monitoring and analysis of incidents and accidents. This was not yet fully implemented or embedded in practice.

There had been some improvements made in the environment, but these were not fully implemented, with some contractor visits booked to undertake work, relating to fire safety, gas, electrics and legionella. There were no records available to show when routine fire safety checks were undertaken, and it was not clear who was responsible for this and if they had been completed prior to the inspection.

There had been an improvement in staff engagement, but this was still in the early days. Since our last inspection there had been one staff meeting and we received feedback that staff had not been kept updated with concerns in the service and actions being taken. Improvements were in the process of being implemented relating to how people using the service and their representatives were being asked for their views of the service.

There had been new care staff recruited, including an activities coordinator to provide social activities to reduce the risks of boredom.

Not all medicine administration records showed people received their medicines as prescribed. A new medicines manager had been appointed and their audits and checks identified there were shortfalls in the safe management of medicines. This was in the process of being improved and systems introduced to improve.

There continued to be no people using the service who had contracted COVID-19. Improvements had been made in the cleaning regime in the service and all staff wore PPE as required. There were systems to support people to have visitors and a programme to test staff and people using the service.

We received positive feedback from people using the service and a health care professional. All feedback received commented on the caring nature of the staff, which was confirmed in our observations. Staff were committed to making improvements and providing people with a good quality service.

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 inadequate (published 6 December 2021).

At our last inspection, the service was rated inadequate with multiple breaches of regulation relating to staffing, governance, safe care and treatment and safeguarding. The provider completed an action plan after the last inspection to show what they would do to improve staff training and by when. At this inspection enough improvement had not been made and the provider was still in breach of regulations and the service remains rated as inadequate.

This service has been in Special Measures since 6 December 2021. The service remains in Special Measures.

Why we inspected

We carried out an unannounced focused inspection of this service on 26 October 2021 to review the key questions safe and well-led only. This was due to concerns received in relation to the management of the service, the safety of people using the service and medicines. The inspection was prompted in part by intelligence received of a specific incident. This incident is subject to a criminal investigation. As a result, the inspection did not examine the circumstances of the incident.

We received concerns that improvements were not being made in a timely way to reduce risks to people receiving unsafe and inappropriate care. We decided to undertake this focused inspection to examine risks and determine whether the provider was following their action plan relating to staff training and improvements were being implemented to meet legal requirements. We also received intelligence that a further incident was subject to a criminal investigation. This inspection did not examine the circumstances of the incident. We reviewed the key questions safe and well-led only. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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. This included checking the provider was meeting COVID-19 vaccination requirements.

At this inspection we found that the service continued to be in breach of regulations and remained inadequate. The provider had started to develop systems to improve and mitigate risks, however these were not yet fully implemented and embedded in practice, some improvements were planned but not yet addressed. This is based on the findings at this inspection.

You can read the report from our last inspections, by selecting the ‘all reports’ link for Priory Paddocks Nursing Home on our website at www.cqc.org.uk.

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 monitor the service and 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 continued breaches in relation to governance, safe care and treatment, staff training and safeguarding at this inspection.

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 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.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Since the previous inspection the providers had employed a manager to assist them in the running of the service. However, at the time of the inspection one of the providers remained the registered manager. 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 service continued to protect people from the risks of abuse or avoidable harm and risks to people were identified and planned for. Where incidents occurred or poor staff practice was identified, action was taken to protect people from harm. Medicines were managed and administered safely and the premises remained clean. There were processes in place to reduce the risk of the spread of infection.

The service continued to ensure that there were enough staff to meet people’s physical, social and emotional needs in a timely way and that recruitment procedures were safe.

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 continued to support this practice.

The service provided people with a choice of appropriate food and drink. Support people required to maintain good nutrition and hydration was reflected in care planning and staff were aware of the support people required. Some improvements could be made to how the meal service is organised and coordinated by staff.

People received care from staff who had the training, skills and experience for their role. The service continued to reward staff for completing mandatory training and to encourage the development of the staff team.

People told us staff were kind to them and the service continued to promote a culture of kindness, with the providers and all staff leading this practice.

The service continued to offer people personalised care based on their individual preferences and to involve people and their representatives in the planning of care. People were supported to have contact with other health professionals where appropriate.

People were provided with adequate sources of meaningful engagement and were supported to feedback their views and experiences through meetings and surveys. Changes were made to the service according to the feedback received. People were made aware of how they could complain and the service had an appropriate complaints policy and procedure in place.

The providers and staff had an understanding of the Gold Standards Framework for end of life care and had a process in place for supporting people coming to the end of their life. The provider and manager told us they were in the process of developing more detailed end of life care planning.

The provider and manager continued to operate an effective system to monitor the quality of the service provided to people. Areas for improvement were identified and acted upon. The service continued to work towards an improvement plan which set out future changes and improvements to the service people were provided with. This took into account feedback from people, their relatives and staff.

Further information is in the detailed findings below.

People told us they were provided with a varied choice of nutritious meals and access to regular drinks. One person told us the food was, 'Good homely cooked food.'

We spent time observing the lunch time routines. We saw that the majority of staff were attentive and supported people to eat their meal in a dignified and respectful manner.

People told us if they had concerns that they felt confident to discuss their concerns with the manager. One person told us, 'I do not have any complaints but if I did have I know the manager would sort things out for me.'