Prema Court

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

We identified 1 breach of regulation in relation to the premises (safety of the environment and infection prevention and control). People and relatives felt the service was generally safe and was an improvement on people’s previous lifestyles. Fire safety measures had not been actioned following a fire risk assessment in 2020. These measures were especially important as some people continued to smoke in their rooms. Actions to address fire safety concerns were starting to be completed at the time of our assessment. The home needed repair and redecoration. Baths and sinks were damaged, walls were cracked, and mouldy sealant was seen in multiple bathrooms. The flooring was damaged in places, floors and skirting boards had ingrained dirt and gardens were overgrown. Risks were assessed but had not been regularly reviewed. Actions identified to manage risks were not always followed. Person-centred care and support plans were not provided to support people with their mental health and wellbeing. The recovery star model was not embedded at the service, with care staff not being aware of the model and not involved in supporting people to maintain their mental health, identify and achieve their goals. Records showed staff needed refresher training in some areas and regular supervision meetings did not take place as planned. Staff had been safely recruited. People received their medicines as prescribed. However, the systems in place did not enable stock quantities to be verified against medicines received and administered and the temperature of the medicines room was too high, which could affect the efficacy of the medicines.

This service scored 47 (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 generally felt safe within the service.

Staff told us they knew how to report accidents and incidents. Seniors said they reviewed the incident reports on the electronic system. Any incidents were discussed in the daily handover meetings. The registered manager told us they reviewed incidents to check that suitable action had been taken. However, documentation did not always reflect this was being completed effectively.

All incidents had been reviewed by the manager. The electronic care planning system alerted the registered manager when a new incident report had been submitted for review. However, processes were not being utilised to analysis accident and incidents for themes and trends and ensure lessons were learnt. A monthly manager’s audit covering a summary of incidents was last completed in January 2024. The local authority had identified that not all incidents had been reported to them as required.

Feedback from relatives was mixed – with 1 relative saying staff knew people’s needs and how to support them, but another relative saying they didn’t think Prema Court was equipped to meet their relative’s needs.

Staff told us they had access to information about people’s needs through care plans and information shared during handover meetings. However, there were no clear strategies recorded for how staff could support people to agree and achieve future goals. Seniors said they had assisted in completing initial assessments of people’s needs with the nurse.

Greater Manchester Mental Health (GMMH) trust had not regularly reviewed people’s needs after they had moved to Prema Court. GMMH had started to complete the overdue reviews shortly before our inspection.

People were not always supported to understand and manage risks. There was a lack of support for people to meaningfully engage in understanding their addiction or mental health and how it can be improved. While some people chose not to engage with services, there were no clear strategies recorded for how staff could support people to move forward.

People told us they generally felt safe within the service. However, there was no evidence people were supported to understand safeguarding and what being safe meant.

Staff understood their responsibilities to keep people safe and felt confident about how to report abuse and that action would be taken. The registered manager said they reviewed all safeguarding reports and made referrals to the Local Authority and CQC if needed. Staff understood the principles of the mental capacity act. People’s capacity was assessed and where people lacked capacity best interest decision were made involving relevant people to ensure people were not unnecessarily restricted when protecting them from risk of harm. Staff knew who had a deprivation of liberties safeguards (DoLS) in place and needed support when going out and who was able to go out on their own.

We observed staff supporting people in line with their assessed capacity and any authorised DoLS restrictions

Suitable processes were in place to safeguard people including oversight of people’s mental capacity and any DoLS applied for and granted. However, it was evident some people were not complying with the conditions of their DoLS. Monthly audits and analysis of any incidents and safeguarding had not been completed since January 2024. The local authority had identified that not all incidents had been reported to them as required.

People were not always supported to understand risks they may be exposed to. Care plans and risk assessments recorded people were to have one to one meeting with the homes Registered Mental health Nurse (RMN) to provide an awareness and support to manage alcohol and drug addiction as well as mental health conditions. Staff said these meeting did occur but there was no evidence they were recorded. There was also no evidence people were supported with a recovery model to promote their wellness.

Staff understood people’s needs and risk and told us this information was readily available within the electronic care planning system and shared as part of handover meetings. A staff member told us, they are aware of the risks of some people who can be quite aggressive. They told us, it depends on what condition the person is in, as to how they respond. This may be talking to them or leaving them alone to gather their thoughts. Seniors had a key work session each month to discuss people’s mental health, risks and care plans. Care plans were reviewed following this meeting. However, there were no records of these meetings and care plans had not been reviewed each month. The manager acknowledged care plans need reviewing so they included more details on the signs to look out for if people are having a mental health relapse. This would enable support and appropriate referrals to medical professionals to be organised quickly to reduce the risk of further mental health issues. Referrals were made to drug and alcohol services if needed, however, many people did not want to engage with these services.

We observed a person leaving the home to purchase alcohol. There were no conversations with the person to discuss reducing their alcohol intake that day or going forward. Staff did not check what time the person would be back or where they were going. We observed people smoking in their rooms.

Risk management strategies was not always clearly recorded. Records stated staff should use de-escalation techniques for signs of aggression but the types of techniques for staff to use were not recorded or agreed. There was a lack of recorded evidence of the support staff should provide to people with addiction of health conditions. One care plan, recorded staff should remind people the negative impact drugs have on people’s mental health but there were no recorded strategies or information to support these conversations. There were no agreed goals set to assist recovery and promote independence recorded in care records. Risk assessments were in place but were not being followed. Two people’s risk assessments recorded they were safe to smoke when supervised but there was evidence, they were regularly smoking in their bedroom unsupervised which was a fire risk. We found care plans for maintaining a safe environment had not been reviewed for 3 months. Weight management was not always safely supported. One person has lost over 10kg within a month and no action had been taken. A person who was at high risk of malnutrition and in receipt of a modified diet due to the risk of choking should have been weighed weekly but was being weighed monthly. The person used fluid thickener to aid swallowing and there was no evidence the amount of fluid thickener being used was recorded.

Relative feedback was mixed. One relative said they were happy with Prema Court, and it was the best their relative had been in terms of their health and mental health. However, another relative thought the building was not fit for purpose. We saw Prema Court had not been well maintained and key work for fire safety systems had not been completed in a timely way.

Staff said they reported any maintenance issues but that some things are repaired but other issues are not. The registered manager acknowledged that a lot of work was required. They said quotes had been obtained for a new wet room and for garden maintenance but then nothing was authorised by head office. The registered manager said the issues with the fire doors had been apparent when they started working at the home 18 months ago, but no action had been taken by head office. The local authority had also identified significant issues with fire safety, the time taken to action these issues and the appearance of the home.

The environment was not safe and posed risks to people’s safety. Some bedrooms had ripped flooring which posed trips hazards as did some of the communal hallway’s flooring. The home required a programme of redecoration as there were cracks within walls and door frames. A fire door had holes in the wooden frame which meant it would be ineffective should a fire occur. The environment was not well maintained. We saw tiles missing in a dining room, damaged bathroom sink units and scorched baths. Settees and chairs in a lounge were broken. Gardens were overgrown. The home needed re-decorating. The kitchen had recently been deep cleaned and new fridges and freezers purchased.

The environment at the home was not safe. Actions from a fire risk assessment in 2020 were only being completed at the time of our inspection. Some people continued to smoke in their bedrooms, which did not trigger the fire alarm. There was evidence of scorch marks in some rooms and bathrooms, including in baths. Staff completed walks of the hallways every 30 minutes to check if people were smoking in their rooms, but we were not assured staff were checking people in their rooms as there was a constant smell of cigarette smoke in the home throughout our visit. Smoking risk assessments identified these staff checks should be made every 15 minutes. People identified as a smoke risk in their rooms had been given a fire blanket for any emergencies. The fire blanket was stored on top of wardrobes and there was no process of what should happen and how staff and people should use the fire blanket in an emergency. For one person who was regularly smoking in their room, the fire blanket could not be located and there were no regular checks to ensure the fire blankets were readily available to use in an emergency. There were weekly fire call point tests recorded to check the fire alarm sounded when the call point was pressed. However, there was no process of which call points should be tested and when. We found 3 fire call points had not been tested at all this year and most call points had only been tested once this year. The registered manager told us, a new, modern fire alarm panel was due to be installed. The garden was overgrown and presented a fire risk as people were regularly extinguishing cigarettes in the area. Issues with the environment had been identified in the monthly registered manager audit but action had not been taken by the provider. Legionella checks were made by an external company. The same issues had been identified for over 12 months and not been rectified.

People and relatives told us the staff were nice and they had a good relationship with them. Sometimes people had to wait to be able to go out with staff.

Staff said there were enough staff on duty to meet people’s needs. They said they had the training for their roles. However, not all staff said they had completed de-escalation training. Care staff did not have any knowledge of the recovery star. This was a model of support for people’s mental health and was used by the seniors. All staff should be involved in supporting people’s mental health following the goals and support identified through the recovery star. Staff said they felt supported and had supervision meetings, however, not all staff had had these recently. Staff were allocated to a floor each shift. However, the ground floor involved a lot more work than other floors, but same number of staff were allocated to each floor. A member of staff said, “We’re told when we’re allocated to a floor we need to stay there; but there may be nothing to do as there are no people on the floor. The ground floor should be 3 staff or allow other staff to come down to help.” The registered manager said they had had trouble recruiting a chef, which had impacted on the care staff. The registered manager said only 1 person had been assessed as having nursing needs, which meant they did not always have a qualified nurse on duty. There was an on call system if staff needed support, staff knew the procedure of calling paramedics or the police if there was a serious incident they could not de-escalate themselves.

There were enough staff to meet people’s needs, although staff also had to complete cleaning of bedrooms alongside the domestic staff, which meant they had less time to interact with people.

Staff received e-learning in a range of topics. Refresher training was needed in infection control, oral health, and safeguarding. The system in place for oversight of the training was not effective to ensure these gaps in training had been addressed. Seniors said they had received training in the mental health recovery star, but care staff were unaware of this model of mental health recovery. The registered manager acknowledged care staff needed to be part of the recovery star support for people’s mental health. Staff supervision meetings were not being completed as planned or as per the provider’s policy. There were no clear systems of oversight of supervision to ensure staff were suitably supported. Planned staff meetings had not always been held. Staff were safely recruited with all pre-employment checks completed prior to starting work.

People did not comment on the cleanliness of the building. One relative said the bedrooms were dirty and thought there was not enough cleaning completed.

Domestic staff were allocated to each floor. They said the job changed and they now had to assist care staff clean people’s bedrooms as well as all the communal areas. They didn’t have a floor cleaner and so had to use mops which didn’t do the job properly. The registered manager said Prema Court was a large building, with a lot of foot fall, so was difficult to keep clean. They had met with care and domestic staff around their roles in cleaning bedrooms as part of their jobs.

The home was unclean in parts. Bathrooms were unclean and there was evidence of ingrained mould in shower cubicles in some bathrooms. The skirting boards and wooden radiator covers in some bathrooms had deteriorated and had begun to rot in places. Sink units were unclean and the sink enclosures were damaged, creating sharp edges of exposed wood. The flooring was damaged in places, which meant it was not possible to fully clean all areas. The stairwells in the home were unclean and corridors were found to have discarded cigarette butts as did some bedrooms. There was a strong smell of cigarette smoke, particularly in Clifton house. Cleaning chemicals were used by staff to assist in keeping the home clean. We found a storage room was left unlocked which allowed vulnerable people access to chemical products.

Infection prevention and control checks were ineffective. The home was unclean in parts and there was evidence of ingrained mould in shower cubicles in some bathrooms. These issues had not been acted upon by the provider.

People received their medicines as prescribed. Where people refused their medicines this was discussed in handover meetings and reported to the GP when needed.

Seniors said they had been trained in medicines administration and had their competency observed. However, processes were not always followed to ensure safe administration of medicines.

People received their medicines as prescribed. Individual medicines files details of any allergies, ‘as required’ protocols and medicines administration records (MARs). However, the stock quantities held could not be checked against the amount of medicines received and administered as the quantity carried forward from 1 month to the next were not recorded. A weekly medicines count was completed, but not for all medicines held. The registered manager completed a monthly medicines spot check. Action plans were written for the nurse and seniors to complete. However, it was not recorded when these actions had been completed. The medicines room temperature was 25 degrees centigrade. Medicines should be stored at below 25 degrees to ensure their efficacy is not affected. An air conditioner unit had been purchased but it vented through an open window so was not efficient. We discussed with the registered manager having the air conditioning unit venting through the wall so the window could be closed. Notes were not made on the MARs sheets when a different code was used. This meant it was not possible to identify why a person had not had their medicines or why they had been administered an ‘as required’ medicine.