We inspected Prideaux House on the 30 June and 03 July 2017. This was an unannounced inspection. Prideaux House provides accommodation, care and support for up to 20 people. On the day of our inspection 15 older people were living at the home. The service provided care and support to people living with dementia, at risk of falls and long term healthcare needs such as diabetes.A manager was in post. They had completed their application to become the registered manager with CQC. An interview date had been confirmed. 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.
We last inspected Prideaux House in March 2016. Breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified and it was rated as requires improvement overall. We asked the provider to make improvements to ensure that care and treatment was provided in a safe way and that quality assurance systems improved. The provider sent us an action plan stating they would have addressed all of these concerns by March 2017.
This unannounced comprehensive inspection on the 30 June and 3 July 2017 found that whilst there were areas still to improve and embed in to everyday practice, there had been significant progress made and that they had now met the breaches of regulation.
People spoke positively about living at Prideaux House. Comments included, “It’s my home” and, I’m very happy here.”
Robust systems had been introduced since the last inspection to assess quality and safety. These included audits for infection control, the environment and equipment used, medicines and daily notes. However, it was acknowledged that because the care plans had been rewritten with outside assistance, the manager had not audited the care plans and therefore had not identified the shortfalls we found during this inspection. These were amended immediately and appropriate action taken.
Since the last inspection people’s care plans had been rewritten, however further work was required to ensure that they reflected people’s changed needs. Records did not consistently reflect the care that was being provided by care staff. As the staff knew people very well this had not impacted on care delivery at this time.
The organisation had put systems in place to ensure staff followed good practice guidance in respect of infection control measures. People who relied on mechanical hoists for moving all had their own sling for everyday use. Staff told us that the slings were checked daily for wear and tear and soiling. All equipment used to assist people had been checked regularly to ensure that they were fit for use and in good repair. The mechanical sluice was operational and staff followed the organisational procedures that ensured that the risk of cross infection was mitigated as far as possible. Medicines were stored, administered, recorded and disposed of safely. Storage facilities throughout the service were appropriate and well managed. ‘As required’ (PRN) medicines had detailed protocols for staff to follow to ensure they were given appropriately and safely. Staffing numbers and the deployment of staff ensured that people received assistance in a timely, caring and respectful manner.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However, some documentation to support specific decisions, such as continued bed rest, were not supported by a clear rationale and best interests meeting.
There were meaningful activities for people to participate in as groups or individually to meet their social and welfare needs.
The provider had established clear emergency contingency plans and evidence of routine maintenance and servicing of equipment such as the home’s boilers were seen to be regularly completed. There was a business plan in place which identified when areas of the premises would be improved.
People received medical assistance from healthcare professionals including district nurses, GPs, chiropodists and optician.
We found people had been supported by staff to maintain their personal appearance in accordance with their wishes.
All staff felt supported by senior staff and had confidence in the provider in running the service. People felt the home was well run and were confident they could raise concerns if they had any.