Primley House

Primley House 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. Primley House accommodates up to 39 people in one adapted building. At the time of our inspection there were 34 people living in Primley House. The home supports people with different needs and backgrounds, including people with mobility needs, health needs and mental health needs.

People’s experience of using this service:

•People spoke very highly of the care they received at Primley House. The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received exceptionally personalised support which met their needs and preferences.

•The registered manager was passionate about continuous improvement and implemented ideas and new ways of working in order to better people’s care and wellbeing. For example, the service had developed a relationship with the local primary school and the local nursery. This brought people a great deal of pleasure. The home also held regular fund-raising events, parties and fetes where people, relatives, staff and members of the public were welcome.

•People were fully involved in the planning and delivery of their care and encouraged to share views and make suggestions about the way the home was run. People were given as many choices as possible and were encouraged to have control and be independent.

•People were given access to a wide range of activities which met their personal preferences. Staff knew people well and were described as being kind and caring. Staff were provided with the training, supervision and support they needed to care for people well.

•The home delivered outstanding end of life care to people. The service was passionate about ensuring people received dignified and respectful end of life care which met their personal needs and preferences. The service had also created a memory garden to show respect for people who had passed away. Each time a person sadly passed, staff planted a rose in this garden to remember them by. This brought comfort to relatives, people who lived in the home and staff.

•Risks to people’s health, safety and wellbeing were assessed and acted upon. During our inspection we identified some medicine stocks did not tally with the stocks recorded on people’s medicine administration records. However, following our inspection the registered manager conducted an audit of medicines and was able to assure themselves and us that people had been receiving their medicines as prescribed.

•People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

•The service had recently changed their care planning system from a paper to a digital format. We found people’s care plans contained clear information about their needs, but further improvements were needed with regards to the amount of personal information and preferences available. People were clear that staff knew them and how to care for them in the way they wanted.

•There was strong leadership at the service. People and staff spoke highly of the management team and there was a positive culture at the service with people and staff feeling their voices were listened to.

•There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Good (20 October 2016). It was rated Good in the Safe, Caring, Responsive and Well-led key questions and Requires Improvement in the Effective key question.

Why we inspected: This inspection was scheduled based on the registration date of the service.

Follow up: We will continue to monitor the intelligence we receive about the service. If any concerning information is received we may inspect sooner.

Primley House was a residential home in Paignton, Devon providing accommodation and care for up to thirty nine people. On the day of our inspection, thirty four people were living at the home. Primley House was a friendly and caring home for older people in the former Georgian Home of the late Herbert Whitley, the founder of Paignton Zoological Gardens. The attractive accommodation consists of two lounges, a large sun lounge overlooking an attractive garden and a spacious dining room overlooking the terrace. In addition there was a library for people to enjoy. People’s rooms varied in size and had en-suite facilities.

The home had a 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 and associated Regulations about how the service is run.

People told us they were happy and felt well cared for. It was clear to see people were comfortable living at Primley House and really felt at home. People’s care was personalised and detailed, and it was evident that staff knew people they were supporting very well. We saw them interacting with kindness and compassion. People and their families described management and staff as caring, respectful and approachable. The families we spoke with had regular contact with the registered manager.

People told us they felt safe, and we found the registered manager had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in safeguarding of vulnerable adults. Staff were knowledgeable about how to recognise and report abuse. We saw risk assessments in place regarding risks associated with people's care. These explained how people's care should be delivered in a safe way and how to reduce any risks involved.

We checked to see if the registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). From discussion with the registered manager it was noted that people using the service had capacity to make decisions and therefore applications to deprive people of their liberty, at this time, were not required. People's care records showed some assessments of people's capacity levels had been carried out but this was an overall assessment of capacity and not decision specific. Where people had the capacity to consent to their care and treatment, the consent was not recorded. Documentation of best interests decisions did not record who had been involved in the decision making process. We made a recommendation that the provider seeks recognised national guidance on the Mental Capacity Act in order to ensure staff support people appropriately and follow this legislation.

Staff had been recruited appropriately to ensure they were suitable to work with vulnerable adults. Recruitment systems and processes that were in place were robust. We saw references and identity checks were carried out, as well as Disclosure and Barring Service checks. People who lived at the home, families and staff told us there were sufficient numbers of staff on duty at all times.

Staff knew how to meet people’s needs. Records showed they had a thorough induction and on going training to help ensure they had the skills and knowledge they needed to provide effective care. We checked to see if staff were receiving regular supervisions, appraisals and checks of their competency to ensure they continued to be effective in their role. Staff records we sampled did not demonstrate that supervisions had been held regularly. However, we were told by staff that they were supported in their roles and had the opportunity to discuss their performance with the registered manager.

We looked at the way in which the home managed people’s medicines. Medicines were secured safely and accurate records were maintained. Staff received regular competency assessment checks to ensure the on-going safe management of medicines. Systems were in place to manage medicines so people received their medicines at the right times.

People and their relatives were involved in planning and agreeing how they were cared for and supported. Care was planned to meet people’s individual needs, abilities and preferences. The care plans were person centred and contained detailed information, setting out exactly how each person should be supported to ensure their needs were met. Care plans were reviewed regularly.

People told us they were satisfied with the meals. We saw that people were offered a nutritious and balanced diet which met their needs. People had a good choice of food and were served drinks and snacks in-between meals. We observed lunch being served and some people required assistance from staff to eat their meals. This was provided in a caring and unrushed manner.

Risks to people’s nutrition were minimised because people were offered meals that were suitable for their individual dietary needs and met their preferences. For example, where people had been assessed as being at risk with regards to their nutrition, we saw appropriate referrals were made to Speech and Language Therapy (SALT) and pureed diets were provided.

Staff ensured people obtained advice and support from other health professionals when their health needs changed. We saw care plans included professionals involved in people's care and referrals were made to other professionals when required

People and relatives were asked for their views about the care provided and informed how to make a complaint or raise any concerns. These were acted on and used to make improvements for people's care when required.

The registered manager’s quality monitoring system included regular checks of people’s care plans, medicines administration and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

One person using the service told us "you won't find a better home."

We saw care workers interacting appropriately with people using the service by speaking to them at their level, and addressing them in their preferred way.

We found that Primley House had systems in place to ensure the care needs of the people living there were appropriately assessed, managed, and reviewed. This meant that people received appropriate safe and effective care.

People living at the home we spoke with told us they were looked after very well. One said 'I am very happy here'. A relative told us 'It's just brilliant'.

We saw clear evidence of the involvement of external healthcare and community support services. We saw that people had opportunities to participate in activities of their choosing. We saw that people were consulted about what they wanted to do, and about how they wanted their care to be delivered.

People said they felt safe living at the home and thought there were enough staff on duty.

All records were well maintained at the home and showed that there were effective