Prema Court

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

We identified 1 breach of regulation in relation to how the service supported people to maintain and improve their mental health. Senior staff used the recovery star model to support people, however the new team leader and care staff did not know about the goals and strategies identified by the seniors and so were not able to support people in their mental health recovery. Staff said they had the information they needed to meet people’s needs. However, not all people living at the service had a named mental health care coordinator and reviews of people’s needs by Greater Manchester Mental Health Foundation Trust (GMMH) had not been completed. Reviews had recently been scheduled by GMMH as a result of concerns raised with them by the local authority. Partner agencies told us the senior management / head office had not always engaged positively with them. A chef had recently been employed and staff said the meals had improved. A deep clean of the kitchen had also been completed and food stocks were appropriate. However, the chef had not been told who required a diabetic alternative for their meals. This was rectified during our inspection.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were prompted or supported to attend health and social care related appointments appropriately.

Staff told us that they had information about people’s needs and how to support them and this information was readily accessible. The registered manager acknowledged further details about the signs a person’s mental health was declining were needed to support the staff team to identify any deterioration in people’s mental health as early as possible so additional support could be provided.

Processes were in place to assess people’s needs prior to admission to the service and risk assessments and care plans were reviewed regularly. However, there were no clear strategies recorded for how staff could support people to move forward. Needs and risk assessments hadn’t been reviewed each month. One person at risk of weight loss had not been weighed weekly as stated in their care plan.

People said the food was generally okay, although some wanted changes made to the menus to include more cultural options. We saw a range of meals, from different cultures was now being followed. However, 1 person told us they had asked for traditional food from their own culture but they hadn’t received it. Adapted crockery was available where needed.

Senior staff said they completed weekly one to one meetings with people to discuss their mental health and wellbeing, using the recovery star model. However, care staff and the new team leader were not aware of this model and so did not know people’s goals or the advice being provided to people as part of this model. The registered manager acknowledged the care staff needed to be involved in supporting people with their mental health and could contribute to their recovery star support. A new chef had been appointed. They were aware of any modified or cultural diets. However, they had not been informed of who was diabetic in the home. This information was given to the chef during the inspection. Staff knew people’s dietary needs and provided support appropriately.

The kitchen had been deep cleaned following concerns raised during a local authority visit. Fridges and freezers were fully stocked, and fresh fruit was available for people if they wished to have it. No records of recovery star meetings or the outcomes were in PCS. The recovery star file in the office contained information about the recovery star, but no records of any meetings with people to use it. The provider was using some best practice guidance and followed the Malnutrition Universal Screening Tool for identifying people at risk of malnutrition. However, for one person who was identified as requiring to be weighed weekly, this was not occurring.

People and relatives told us the staff were nice and they had a good relationship with them.

Staff said they worked well together as a team. Referrals were made to the drug and alcohol teams when appropriate. However, many people chose not to engage with these teams. The registered manager said people’s needs had recently been reviewed by the Greater Manchester Mental Health (GMMH) teams. However, prior to this, reviews had not taken place, in some cases for several years.

Feedback from professionals was that the provider had not always engaged positively with them when issues had been identified. Improvements to working relationships between the service and other agencies were needed and action was ongoing.

Greater Manchester Mental Health trust had not worked with the service to regularly review people’s needs. Reviews had recently started to be completed.

People told us they were prompted or supported to attend health and social care related appointments appropriately. However, there was no evidence people were encouraged to make healthier choices to maintain their health.

Staff said referrals could be made to the GP and psychiatry services when required. The GP did not complete a weekly ward round but was responsive to requests for a home visit. The registered manager also said the psychiatry service was responsive when an appointment was requested. Staff would support people to attend appointments if required. However, there was no evidence people were being supported to manage their mental health through the recovery star model.

There was a lack of support for people to manage their health and wellbeing so they can maximise their independence, choice and control. There was no evidence people were encouraged to make healthier choices to maintain their health and wellbeing. Care plans recorded people should have weekly one to one session with the nurse or key workers to promote health and wellbeing but there was no evidence of these occurring.

Feedback from relatives was mixed. One relative was positive about the support provided at Prema Court, saying, “Staff know [Name’s] mental health needs. Their health and mental health is the best it's ever been.” However, another said, “I don’t think they are equipped to fully meet [Name’s] needs.”

Staff said they promoted people’s independence and encouraged people to complete tasks themselves wherever possible. The registered manager gave examples of how some people’s mental health and lifestyle had changed and improved since living at Prema Court. However, the recovery star model was not embedded within the whole staff team to aid people’s recovery and support them to move on to more independent settings. Signs people may be having a mental health relapse were not clearly identified to ensure early interventions could be made.

We did not find any evidence of people being supported to achieve positive outcomes as agreed expectations and goals were not always discussed or recorded. Partners had raised concerns about people’s personal hygiene and presentation which affected their dignity.

We observed one person being reminded they were able to make decisions about their own money.

Staff understood the importance of obtaining consent and supporting and encouraging people to make decisions for themselves. Staff knew they could encourage people but were not able to make them do something they did not want to do.

There was no evidence people had consented to their care plan or being involved in care planning. People’s capacity had been taken into account where people were able to manage their personal finances.