We carried out a review of the data available to us about Primrose Villa on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Primrose Villa, you can give feedback on this service.
About the service
Primrose Villa is a residential care home providing personal care for up to seven people. At the time of the inspection six people were living at the home.
People’s experience of using this service and what we found
Based on our review of the key questions safe and well-led, the home was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right Support
The model of care and setting maximised people's choice, control and independence. The home had good access to the local community and amenities. 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 focused on people's strengths and encouraged them in their individual interests. We observed one person enjoying a makeup and hair session with staff. Another person liked to use the homes exercise equipment which included a running machine. Another person told us they liked to go out for meals and take part in social events which were run by another organisation.
People were supported by enough staff on duty. People received their medicines in a safe way. People were protected from abuse and neglect. People's care records and risk assessments were clear and up to date.
Right Care
Staff knew people well and demonstrated an understanding of people's individual care, behavioural and communication needs. This helped ensure people people's views were heard and their diverse needs met.
People could communicate with staff. Staff understood their individual communication needs and were consistent in their approach and response. People’s care plans informed staff of any specific ways to best communicate with people.
The core staff team had the appropriate levels of knowledge and skills to support people and responded to their individual needs and choices. Staff promoted people's dignity and treated them respectfully. They understood people's needs and provided security and encouragement.
Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.
Right Culture
The staff at Primrose Villa were committed to ensuring people were leading the lives they wanted. Staff created an environment that inspired people to understand and achieve their goals and ambitions.
People received care which was inclusive and directed by them. Staff knew and understood people well and put their needs at the heart of the support they provided. Staff ensured people were involved in their care plans and that they promoted people's right to independence and choice.
Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Primrose Villa is a care home in a large Victorian house set over three floors. Communal areas include a living/dining area and separate lounge, a kitchen area and enclosed garden. All bedrooms are located on the first and second floors, including a staff sleep-in room.
The service provides personal care and accommodation for up to seven people who have learning disabilities and additional needs. Seven people were receiving support at the time of our inspection.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
People liked living at Primrose Villa. Staff provided kind and caring support and treated people with dignity and respect.
People were safe and protected from avoidable harm. Risks were monitored and addressed, and the environment met people’s needs. We made a recommendation about reviewing the information kept by the service.
People were supported by enough staff. Staff were safely recruited and well supported. Staff usually received training, supervision and appraisals. Some staff had not had supervision as frequently as the provider required, but a plan was in place to address this.
People's medicines were administered and managed safely by staff. Staff received training and the provider regularly checked staff’s competency in the management of medicines.
People accessed routine and specialist healthcare services as required and were supported to eat and drink enough to remain healthy. Staff understood how to meet people’s specific dietary needs, such as diabetes.
People received individualised support and were treated with dignity and respect. Care plans were personalised and helped identify what was important to people. People were involved in decision making and reviewing their support needs where possible.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
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.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support usually focused on them having opportunities to gain new skills and become more independent.
People were supported to maintain social relationships and participate in a range of activities. A plan was in place to develop activities further.
Staff felt supported by the management team and governance systems were in place to ensure high quality care was provided. Audits were carried out regularly to review quality and performance. Action plans enabled the provider to monitor changes and improve care for people.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of the thematic review, we carried out a survey with the management team during this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.
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 (report published 04 April 2017).
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.
There was a registered manager for the service. 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.
Two people at the home reported an allegation to us during our visit .It was alleged a staff member could be harsh and abrasive towards people. The registered manager took action at the time of our visit to ensure that people were safe.
People were supported with their range of needs by enough staff to provide them with safe and suitable care. The staff rotas showed and the registered manager told us, that staffing numbers were increased when it was needed. If people’s needs changed due to being physically unwell, or there were extra community based events taking place there would be additional staff rostered to work.
The provider had a system in place to aim to protect the rights and freedoms of people at the home. The provider ensured that the requirements of the Mental Capacity Act 2005 were implemented when needed. This legislation protects the rights of people who lack capacity to make informed decisions about different aspects of their lives.
Staff received support and training to carry out their roles effectively. The staff said they felt supported by the registered manager and deputy manager. People also told us they felt they could raise issues or concerns to management. There was a procedure in place to manage and respond to complaints. The complaints procedure helped to ensure that complaint would be taken seriously, investigated and resolution to the satisfaction of the person concerned.
People said that they liked the meal choices, and we saw they were encouraged to prepare and cook meals, snacks and drinks. Care plans showed how to support people who had specific nutritional needs.
We saw staff were caring and friendly in manner toward the people they supported. People told us they had had built up close and caring relationship’s with the staff. We saw staff ensured that privacy and dignity were respected. The staff provided people with explanations and information so they could make choices about aspects of their lives.
Care plans explained how to meet the care and support needs of the person that they were written about. If people chose to they were involved in the planning and writing of their care plans. This was to help ensure that people able to say how they wanted to be supported and in the ways they would prefer.
People were well supported to eat and drink enough to be healthy. To help people to be independent people were encouraged to buy and prepare meals and snacks with the support of staff.
People were able to take part in a variety of individual social activities both in and out of the home Some people told us that they went to college during the week as well as out for trips into the local area.
The provider had a system in place to help to ensure that complaints were investigated and responded to properly. People knew how to make their views known and they had up to date information available to help them to make a complaint. The registered manager knew people very well and they said that she was a” very nice person” who they could speak to at any time.
There was a programme of quality monitoring and checking in place. Where issues were identified as a result of this, action was taken to improve the overall quality of the service. A recent quality monitoring check had found an issue in relation to the information that was written in care plans about people. The registered manager had put in place an action plan to address this shortfall in care planning.
We carried out this inspection on 26 January 2016 and this was an unannounced inspection. When Primrose Villa was last inspected in July 2014 no concerns were identified at the service.
Primrose Villa provides accommodation and personal care for up to seven people with a learning disabilities. At the time of our inspection there were seven people using the service.
A registered manager was in not post at the time of our inspection. 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 previous registered manager had left in November 2015. A manager was in post at Primrose Villa who was currently completing their registration process with the Commission.
Training in challenging behaviour had not been completed. This placed both the staff and people living at the service at risk.
The provider had not ensured that current medicines information was available for trained staff despite being previously advised. People’s photographs within their medicines folders were undated which had also been previously highlighted by a pharmacist in July 2015 as requiring action. Incidents and accidents were recorded however staff had inconsistently recorded matters.
Staff received support through training and supervision. People were supported with meals and drinks when required. People were involved in choosing their meals. Where needed, the service had made referrals to healthcare professionals and health plans were in place.
The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. Staff demonstrated a good working knowledge of the Mental Capacity Act 2005.
People felt safe and told us they had a good relationship with the staff. People’s identified risks were recorded and risk management guidance was available. There were sufficient numbers of staff on duty and staff knew their responsibilities in relation to safeguarding. Staff recruitment procedures were safe and the environment and equipment was tested and serviced to ensure it was safe.
People said the staff at the service were kind. People had a keyworker to provide personalised support and we observed that interactions between staff and people were positive. People had their privacy respected and staff we spoke with understood the people they cared for well.
The service was responsive to people’s needs. People, their relatives or representatives were involved in care planning and reviews. The care plans we reviewed were person centred and contained unique information about people and how to meet their needs. People were given key information about the service. There were activities people could participate in if they chose. The provider had a complaints procedure and system in operation.
People knew who the manager was and who to approach if they had any concerns. Staff told us they were happy with their employment and felt supported by the manager. There were systems in operation to communicate key messages to staff. People had the chance to express their views and opinions.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.
At the time of our inspection there were seven people living permanently in the home. We observed the care being provided to people in the communal areas of the home and examined the care documentation and supporting records. We spoke with three people that used the service who were able to tell us of their experiences and we spoke with two members of staff to gain their understanding of how they met the needs of people living in the home.
Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people using the service, the staff supporting them and looking at records.
If you wish to see the evidence supporting our summary please read the full report.
Is it safe?
Staffing was maintained at safe levels. During our inspection people's needs were responded to in a timely manner. Staff received training in safeguarding adults. People we spoke with told us they felt safe living in the home and knew who to tell if they didn't. One person told us 'we always discuss it at our meetings. If I wasn't happy I would tell staff and my Mum'.
Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff had a good understanding of who they needed to contact should they have any concerns around people's welfare.
People who used the service were cared for by staff who knew how to protect them from the risk of abuse. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (Dols). The senior member of staff confirmed no one currently living in the home was subject to such an application. However relevant staff had been trained to understand when an application may be required. This meant that people were safeguarded from abuse.
Is it caring?
People were supported by sensitive and attentive staff. Comments we received from people living in the home were positive. Comments included: 'I went to Weymouth I was very happy'. 'I chose the colour of my bedroom and I have a new mirror. Staff help me they are nice'.
We saw that care staff showed patience and gave encouragement when supporting people. We spent time in the communal lounge observing interactions between staff and people that used the service.
The observations we made demonstrated staff supported people in a calm unhurried manner, using communication methods conducive with their individual assessed needs.
Is it effective?
We found people's health and care needs were assessed with them and reviewed regularly. Care plans provided guidance for staff to follow to ensure people's individual specific needs were met. Care plans were reflective of people's current level of need.
Specialist dietary, mobility and equipment needs had been identified in care plans where required. People also had supplementary files that held detailed information about their health needs and detailed any changes. This information travelled with the person when they visited health professionals. People told us their keyworker met with them on a monthly basis and this was evidenced in people's files.
It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. People we spoke with confirmed this.
Is it responsive?
People received co-ordinated care. We saw evidence in people's care plans that demonstrated people had been visited by their GP and other health care professionals. Records demonstrated they visited on a regular basis by external health and social care professionals as required.
Evidence was viewed in people's care documentation to evidence that should people experience any changes in their needs, professional advice was sought swiftly to ensure people's care and welfare was maintained.
Is it well led?
A stable management team was in place. We were told the registered manager was approachable and staff we spoke with felt supported by the whole management team.
People that used the service, their relatives and external professionals completed a satisfaction survey once a year. Comments we viewed were positive from people that used the service. Comments included: 'I enjoy living in Primrose Villa as I have my friends here'. 'Staff are very helpful and support me when I need it'.
The senior person told us if any concerns were raised these would be addressed promptly and people were encouraged to raise any concerns or worries on a daily basis and at residents meetings called 'your voice'. Minutes we viewed confirmed this.
People's comments included; 'I go out on activities and I work in a charity shop', 'I get help with what I need, I like living here', 'I do Spanish on a Tuesday night' and another person told us they had recently been on holiday and how they 'really enjoyed it'.
People who used the service also told us how they had a key to their own room and some people had a front door key.
People were supported in promoting their independence and community involvement. One person told us 'we all share the household chores and do cooking one night a week'. Another person told us how they accessed a local community college course.
We asked staff what it was like to work at Primrose Villa and comments included; 'we are a good team', 'I get enough support and training here' "Its a great place to work".
Throughout our inspection we saw that staff engaged with people positively and in a calm manner. People were observed moving freely around the home and taking part in 'activities of daily living'. For example, we observed people being supported with their washing and household chores, before they went out for the day on chosen activities.
We spoke with four people that use the service, four members of staff and one relative throughout the inspection to gain an understanding of the service being offered to people.
Some people we spoke with told us 'I've lived here a couple of years, its lovely' 'I'm going to college to do money skills, French and cooking, I also have a job'. Other comments include; 'I like it here, I like helping', 'I went to Spain last year it was great!' 'It's more independent living that's why I moved here'.
Staff told us they encourage people to be as independent as possible and they encourage people to access local community services and activities.
We asked staff what it was like to work at Primrose Villa and comments included; 'There's always senior support available', 'We are a good team', 'I love it it's very meaningful work'.
Throughout our inspection we saw that staff engaged with people positively in a calm and relaxed manner. People were relaxed and engaged in their own environment.
We met a family member who was visiting the home. They said they were happy with the care of their relative and that staff involved them and informed them of any changes to their relatives care needs.
We spoke to a person living at the home who told us :
'Staff help me with money, go to the bank with me, help me withdraw money. I sign for it.'
' Help with vegetables and with shopping and choosing food I like'
'Go out on own to pub and corner shop' and 'Get taken to college by staff in car or get a taxi'
'Trips out at weekends like Weston, and the downs, get out quite a bit.'
'Like the staff and feel safe at Primrose Villa.'
'I would go to xxxxx if I was unhappy or worried about anything'