Archived: Priory Court Care Home

Priory Court Care and Nursing Home is a residential care home providing personal care to up to 71 people. The service provides support to older people, people with dementia and people with a physical disability. At the time of our inspection, there were 20 people using the service. In response to findings at our previous inspection, the provider had amended their registration and no longer provided nursing care at the time of this inspection.

Priory Court Care and Nursing Home provides accommodation across three floors. At the time of our inspection, the first floor had been closed and people were occupying bedrooms on the ground and second floors. Both floors provide people with access to communal toilets, washing facilities, dining and lounging areas. People have level access to a well-stocked garden from the ground floor. The registered manager’s office is located adjacent to the reception area.

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

In response to findings at our last inspection, the nominated individual and operations team had increased provider-level visits to the service. Additionally, the recently appointed registered manager had worked to introduce a programme of quality audits and checks in line with the provider’s policies. The service had worked with external professionals to drive improvement and had an action plan to sustain improvements made to date.

At our last inspection, we identified people had not received support in a caring way. At this inspection, we found significant improvements had been made, including staff re-training around dignity. People told us staff were kind to them.

Since our last inspection the registered manager, operations team and staff had worked to make significant improvements. People were no longer at risk of experiencing avoidable harm and abuse. Potential risks were assessed, managed and mitigated. Staff confirmed staffing levels had improved and there were sufficient numbers of staff to meet peoples’ needs. We received mixed comments from people about staffing levels.

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 21 September 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection, we recommended recruitment processes were reviewed and amended to ensure checks were undertaken in line with requirements. At this inspection, we found improvements had been made to ensure recruitment checks were undertaken consistently.

At our last inspection, we recommended the provider review and amend systems in relation to the application of topical creams. At this inspection, we found enough improvement had been made and topical creams were applied in line with published guidance about best practice.

This service has been in Special Measures since September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Priory Court Care and Nursing Home is a nursing home, and was providing personal and nursing care to 57 people aged 65 and over at the time of the inspection. The service can support up to 71 people.

Priory Court Care and Nursing Home is a former nunnery and provides accommodation over three floors. Each floor is accessible by stairs and a lift. People living with advanced dementia are supported and accommodated on the third floor. Bedrooms provide en-suite hand washing and toilet facilities, some provide a shower, additional communal toilets, bath and shower rooms are situated throughout. Each floor has a communal dining space and lounge. People have level access to a well-stocked garden. The registered manager’s office is located on the ground floor adjacent to the home’s entrance and reception area. Parking is available to the front of the home.

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

Not enough staff were deployed across the service. This meant people did not always receive the care and support they needed, or they experienced a delay. Recruitment practices were not always completed in line with regulatory requirements. We made one recommendation in relation to the recruitment of staff. People were at risk of avoidable harm and abuse, this included failures to identify and investigate potential indicators of abuse. People were not always protected from the spread of COVID-19. Medicines were managed safely, we made one recommendation about guidance in relation to the application of topical creams.

Peoples’ dignity and respect was not always maintained. We identified the service’s tablet had been used to take undignified photographs of people. A staff member had cut one person’s hair without their consent. People were not consulted about staff taking their breaks and smoking in the ‘resident’s garden’. People told us staff were kind and caring.

Quality checks and audits had not been used effectively to identify the concerns, errors and omissions we found during our inspection. Staff told us the registered manager was not working in the home often enough. When feedback was sought and concerns were disclosed, the registered manager did not always act to investigate concerns and improve care provision. Staff told us morale was low. Statutory notifications were submitted to the Care Quality Commission as required. Staff worked in partnership with external organisations and professionals, including the GP.

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 5 September 2020)

Why we inspected

We received concerns in relation to staffing and care provision. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

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.

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.

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

We have found evidence that the provider needs to make improvement. Please see the safe, caring 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.

In response to our findings, we requested assurances about how the service planned to ensure people were kept safe. The service submitted an action plan and weekly updates. Safety measures were implemented immediately, including increased staffing levels.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Priory Court Care and 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 people receiving safe care, being placed at risk of abuse and failing to ensure people’s dignity and privacy was respected. Additionally, concerns, errors and omissions we found during this inspection were not identified by the service, demonstrating a breach of good governance.

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.

Special Measures

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.

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.

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, 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.

Priory Court Care and Nursing Home is registered to provide personal care and accommodation for up to 71 older people over three floors. At the time of our inspection 55 people were using the service.

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

During this inspection we did not speak directly with people at the service due to the increased risks associated with the Covid-19 pandemic. People appeared relaxed and had a good rapport with staff. Staff demonstrated a good awareness of the safeguarding processes and told us they would feel comfortable raising concerns with the registered manager.

People’s relatives gave us positive feedback about the quality of care people received, however they also said they felt communication could be improved in places. There were governance systems in place to monitor the quality and safety of care provided. Whilst some systems were effective, we identified a small number of records that were inaccurate or incomplete. Although there was no impact on people, this did not evidence a fully effective governance system.

Risks to people were identified, and care was planned to minimise known risks. Care plans were person focussed, clear and all had risk assessments relevant to the aspect of care covered. We identified that care planning in relation to diabetes care and treatment could be more personalised and have made a recommendation about this.

There were effective systems that ensured the service was safe. Health and safety checks, together with effective checks of the environment were completed. Medicines were managed safely and there were systems for learning when things could be improved. There were appropriate infection control systems in place.

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. We identified some recording improvements were required around capacity assessing and best interest processes. We communicated this to the service management.

Care was planned based on pre-admission assessments and nationally recognised tools used in the delivery and monitoring of care. People were supported by trained staff and staff were supported through supervision and appraisal. Staff at the service worked together and escalated concerns to healthcare professionals when needed.

There were systems to seek the views of people and staff through surveys. Additional surveys had been completed during the Covid-19 period to seek the views of people and staff on how they felt the service was responding to the associated risks.

Rating at last inspection

The last rating for this service was Good (published 31 January 2018).

Why we inspected

We received concerns from other healthcare professionals in relation to medicines, clinical care and effective governance. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only. 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 not changed based on the findings at this inspection.

We found some evidence during this inspection that governance systems were not always fully effective and that communication could be improved. Please see the Safe, Effective and Well-Led sections of this full report.

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

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The Burnham Nursing and Residential Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The Burnham Nursing and Residential Centre is registered to provide personal care and accommodation for up to 71 older people. At the time of our inspection 43 people were using the service. Accommodation was provided over three floors but at the time of the inspection only two floors were occupied. The upper floor had undergone an extensive renovation and redecoration programme and was ready to be occupied.

Following the last inspection in August 2016 we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; Safe, Effective, Responsive and Well led, to at least good.

At the last inspection we found people were not always safe. Risks to people were not well managed and there were times when there were not enough staff to keep people safe. Staff who administered medicines did not have an up to date competency check. Some staff did not know how to report concerns to the local authority if they had concerns about a person’s safety.

At this inspection we found there were systems and processes in place to minimise risks to people, care plans showed risk had been assessed and clear guidelines were in place for staff to follow. This also included a robust recruitment process and making sure staff knew how to recognise and report abuse.

There was sufficient staff to safely meet the needs of people living in the home. People’s opinions on staffing levels varied with some people still concerned about the use of agency staff. However the registered manager confirmed a recruitment programme was on-going and they had employed permanent staff to provide continuity of care. Records showed that there were adequate numbers of staff available to meet the assessed needs of people in a timely manner.

At the last inspection we found the service was not always effective. Staff did not have a clear understanding of the Mental Capacity Act 2005 (MCA). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. When people are assessed as not having the capacity to make a decision, a best interest decision is made involving people who know the person well and other professionals, where relevant. We also found Staff were not always aware of people's food allergies or need to avoid specific drinks.

At this inspection we found staff had received training in the MCA and could discuss how they recognised people’s ability to consent to care. People received effective care from staff who understood their needs. Staff were able to tell us about people’s specific likes and dislikes. People told us they thought staff were well trained and understood them well. The registered manager and staff were very pro-active in arranging for people to see health care professionals according to their individual needs.

All staff attended induction training before they started to work in the home. All staff said they had plenty of opportunities for training and the organisation also promoted dementia awareness training for all their staff.

At the last inspection we found the service was not always responsive. People’s care plans were inconsistent and care staff did not have access to people’s care plans. People or their relatives were not involved in developing their care plans.

At this inspection we found people received care that was responsive to their needs and personalised to their wishes and preferences. People were able to make choices about all aspects of their day to day lives. Care staff had access to care plans that were clearly written and included plenty of guidance and information to support them in meeting the needs of people living in the home.

At the last inspection we found the service was not consistently well led. Some quality assurance systems failed to effectively identify areas requiring improvement.

At this inspection we found a lot of hard work had been put into ensuring the systems in place identified where improvements were needed and action was taken to continually drive improvement within the service. There were formal and informal quality assurance systems in place to monitor care and plan on-going improvements. There were audits and checks in place to monitor safety and quality of care.

The service was well run by a registered manager who had the skills and experience to run the home so people received high quality person-centred care. The manager led a team of staff who shared their commitment to improving standards of care and had a clear vision of the type of home they hoped to create for people.

We saw extensive work had been carried on the renovation and redecoration of the top floor of the building. This had been renovated to a high standard and was ready to be occupied. On-going renovation and redecoration was also evident on the other floors in the home.

People could enjoy a full programme of activities and staff had built up links with the local community to ensure people could stay in touch with organisations such as their place of worship and the local school. People told us the activities organiser worked hard to keep them entertained and occupied.

People said they received care and support from caring and kind staff comments included, “The staff are nice and they care”. And “There are some really lovely staff here”.

This inspection was unannounced and took place on 10 and 11 August 2016.

The registered manager had recently left and two temporary managers were in post, having taken over in March 2016. 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.

Most people we spoke with were concerned about staffing levels in the home. Although we observed staff to be rushed and people told us they waited sometimes, they were happy with the care they received and interacted well with staff. Experienced staff had built good relationships with people. The managers had developed links with the community.

Although staff received training, some staff we spoke with did not understand their responsibilities around safeguarding. Staff received training for other topics, such as manual handling, but had not received support via supervision through a time of significant change.

There had been a number of changes in the management team since our last inspection. This had led to a period of inconsistency. Everyone we spoke with felt the new, temporary managers were making positive changes and the service was improving.

People, and those close to them, told us they were not involved in planning and reviewing their care and support after their initial meetings when they moved in to the home. Care staff did not have access to people’s care plans because they didn’t have access to them, so relied on information being passed to them from the nurses.

People’s views on meals were mixed. Cooks had not been made aware of everyone’s dietary needs, allergies and preferences. People were not involved in menu planning.

The quality assurance processes in place to monitor care and safety and plan ongoing improvements were not fully effective. There were systems in place to share information and seek people’s views about the home. Complaints and concerns were not always used to improve the service. A number of compliments had been received.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because:

• people, relatives, visitors and staff all said there were not enough staff,

• care and treatment was not always provided in a safe way,

• some people were subject to unauthorised restrictions,

• staff had not been supervised regularly,

• people did not received person centred care

• the quality assurance processes in place to monitor care and safety and plan ongoing improvements were not fully effective.

You can see what action we told the provider to take at the back of the full version of the report.