Archived: Priestley

Priestley is a ‘care home’. People in care homes receive accommodation and 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. Priestley is registered to provide accommodation for up to forty people who require residential care. The home is purpose built and has a ground and first floor. There are bedrooms and a communal lounge and dining area on both floors. There were 40 people living at the home at the time of our inspection.

The service had a registered manager in place. 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.

People told us they felt safe, although we found one person’s moving and handling information was not reflective of their current needs and there was no record kept to ensure staff were aware of the correct settings for people’s pressure mattresses. There was a system in place to ensure the premises and equipment was serviced and maintained to reduce the risk of harm to people and staff.

There were sufficient numbers of staff to meet people’s needs. The procedure for recruiting staff reduced the risk of employing a member of staff who may not be suitable to work with vulnerable people.

Some aspects of medicines management needed further improvement. For example; one person had not been receiving their nutritional supplements, the location of pain relief patches were not consistently recorded on a body map and not all ‘as required’ or variable dose medicines had a protocol in place to ensure safe and consistent administration. We have made a recommendation about the management of some medicines.

A programme of induction and shadowing was in place to support new staff. All staff received regular updates to their training and supervision throughout the year from a more senior colleague.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People made positive comments about the meals. We saw people were provided with a choice of drinks, snacks and meals throughout the day. The meal time experience was calm and relaxed. However, one person was not receiving the food texture as recommended by a speech therapist and no further assessment had been requested. However, we spoke with a visiting GP who was highly complementary about the home and staff.

People told us staff were caring. Throughout the inspection we observed staff to be kind, attentive but professional. People’s care was delivered in a manner which respected their right to privacy, maintained their dignity and was centred around their individual preferences.

There was a range of activities for people to participate in, including trips out. Feedback regarding this was positive. Care plans were person centred and people and comments from a recent satisfaction survey showed people felt involved in their care plans.

Where a complaint had been received, we saw the registered manager had investigated the issues raised and responded to the complainant with their findings.

Staff and people who lived at the home spoke positively about the management of the home. There was a system of audits in place, completed internally and by senior managers, to ensure the quality of the service people received was continually monitored. Although the governance system had not identified the issues we raised while we were completing our inspection. Regular feedback was gained from staff and people who lived at the home.

The registered manager was present on the day we inspected. 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.

People told us they felt safe and relatives also had confidence in the staff providing care. Staff were able to explain how they would respond to any concerns and what action they would take if they did not feel they were taken seriously enough.

Risk assessments varied in quality and although based on people’s own abilities, were not always detailed enough to provide clear guidance to staff, especially in relation to supporting people moving and handling needs. This had been identified by the Operations Manager in a recent visit and work was underway to tackle this area.

Staff were extremely busy all day and very task-focused. They were responsive to people’s needs but did not have time to talk to people individually which meant the atmosphere at sometimes felt fraught and hurried. We observed one person not receiving timely continence care which was a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as there were not enough staff to provide prompt and regular support for people.

There were issues with the administration of medication as people were not always witnessed taking it. Records were completed incorrectly as a result as staff wrongly assumed tablets had been taken. Creams and drops were not dated on opening which meant there was a risk medicines were used past their expiry date. This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as people were not receiving their medicines in a safe manner.

Staff had access to an induction, supervision and ongoing training although some needed to complete refresher courses in relation to moving and handling practice.

The registered manager had requested Deprivation of Liberty Safeguards (DoLS) for people in the home and was awaiting the outcome of these applications. One urgent DoLS had been authorised and was being correctly adhered to. Staff had a good understanding of mental capacity but records did not always correspond with all aspects of this legislation.

People were supported with their nutritional and hydration needs and pressure care relief was given as required. People had access to external health and social care professionals when needed.

Parts of the home had a strong malodour which had been raised with the registered provider on a number of occasions and the registered manager was awaiting replacement carpets and furniture.

Staff were patient, kind and enabling to people despite being busy. They always acknowledged people and it was clear they knew everyone well. They sought people’s consent when carrying out care tasks, however, we could not always see written evidence of this by the necessary parties.

We observed some staff enter people’s rooms without knocking first although they did make their presence known. People’s dignity was respected for most people apart from one incident where a person needed urgent continence care which could have been provided earlier.

Activities were limited and people did not have a lot to do during the morning apart from attend the hairdresser. Staff were occupied in moving people into wheelchairs for this which took most of their morning as this required two staff.

People’s care records were based on their own situation but not all recording was person-centred. The daily records focused on tasks that had been carried out rather than a person’s experience of that day.

All feedback we received was positive from people and relatives. Staff felt supported in their role by the registered manager, who in turn was supported by the operations manager. Direction was given to staff and evidence form meeting minutes showed that expected standards were clear and shared.

The quality assurance system was comprehensive and detailed. However, although action points were agreed as completed we did not always see these in practice during our inspection. This meant that sustainability needed further consideration.

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

At the time of this inspection, 34 people were living at Priestley. We observed the care those people received. We spoke with four people who used the service and three members of staff. We also spoke with the manager, as well as reviewing relevant documentation.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask: is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found.

Is the service safe?

There were risk assessments in place where required for people using the service in relation to their support and care provision. This meant action to minimise risks to people were being considered, for example, falls.

Our observations of the care provided to people was what we had seen recorded in people's care plans and what staff had told us. For example, we observed that staff used identified moving and handling practices, in accordance with the person's care plan, so that people were moved safely. We also saw that other equipment they needed to meet their needs and maintain their safety, such as walking frames were in place.

Documents relevant to staff's recruitment were in place before staff commenced work and staff did not start work until they had completed their induction training and worked shadowing experienced staff at the home.

There were enough members of staff to keep people safe and meet their health and welfare needs, but all staff we spoke with said it was a constant struggle to meet people's needs with the current levels of staffing, particularly at night because the dependency of people was so high. People and relatives had also raised questions about what the numbers of staff should be to meet people's needs at the last resident and relative meeting. All the people we spoke with told us staff came quite quickly if they rang for assistance. Their comments included, 'they [the staff] work very hard. They come when I need them, I never have to wait', 'they come quite quickly really, but sometimes I wish they'd come a bit quicker', 'I don't buzz much, but when I do they come quite quickly' and 'they have enough staff for me'.

Is the service effective?

People's health and care needs were assessed and care plans formulated. This assisted staff in knowing what they needed to do to care for people, so that their needs were met.

An activity worker was employed and we saw a small part of the activities they provided to stimulate people and enhance their wellbeing. On the day of the inspection this included sitting with people in the upstairs lounge chatting to them. When we spoke with people they were aware about activities that took place, but didn't participate, preferring their own company and doing what they wished, for example, crosswords, reading and knitting.

Is the service caring?

Discussion with people told us they were fully involved in their plan of care and were included in decisions made about them, but not all aware they had a written plan of care where all that information was stored. Comments about the care provided included, 'it's excellent. They wash and shave me every day. I have a bath every week, although I'd like one every day. There's plenty to eat and drink', 'I get up and go to bed after lunch usually. I go to the hospital and the district nurse comes to see me. They treat you well and I wouldn't want to be anywhere else. My daughter chose it. I used to have a bath every week, but now have a good wash every day. They use the hoist to get me in and out of bed', 'I'm quite happy, but I do most things for myself. We're like a family. There's no arguing or falling out' and 'it's very nice, but nothing's perfect. Most staff are lovely and respectful, but some, when you complain, just walk away. I think that when they get to know you, they know what you like'.

We saw staff used a friendly and kind approach when speaking with people. They demonstrated patience and gave encouragement when supporting people. They spoke with people in a courteous and respectful manner during our visit. We heard staff treat people with kindness and compassion when providing their day to day care. Our observations of staff whilst they spoke with people told us that staff had a clear knowledge of people's individual likes and preferences.

Is the service responsive?

When we spoke with people they were aware of who the manager was and felt confident in raising concerns should they have any. The complaints procedure was displayed throughout the home and was displayed on people's bedroom doors. This meant people were provided with information on how to make a complaint should they need to.

Is the service well-led?

The manager of the service was not registered with the CQC which is a requirement of the home's registration. We are monitoring this as the home have been without a registered manager since 7 June 2011. The current manager was appointed in February 2014 and said she was in the process of registering with CQC.

There was an effective system to regularly assess and monitor the quality of service that people receive. This included six monthly resident and relative meetings and monthly surveys. Examples of discussion items at the resident and relative meeting included encouraging people to look at their care plans, decoration, activities, food and the level of care provided. People were also told they could speak with staff in private about any matter should they wish. This meant people and their relatives were provided with an opportunity to give their views of the service and any suggestions for improvement.

In regard to the identification, assessment and management of risk the manager explained audits and analysis of various aspects of the service took place on a planned basis. We saw evidence of those and these included actions to maintain compliance with fire, legionella, care provision, medication, the environment, complaints, bed rails and infection control. We saw that accidents and incidents, injuries, weight loss and pressure damage had been analysed.

The manager said any learning from the above was shared with staff through six monthly staff meetings, quarterly supervisions and for anything more urgent at shift handovers.

When we spoke with staff they were satisfied with the support provided for them and that they felt they could approach the manager if they needed to. One staff member said, 'it's a good support network'. Another said, 'I feel supported. The seniors, deputies and manager are always happy to help'.

One person told us 'The lengths that staff go to, to make sure we are well cared for is outstanding. They all treat me with dignity and respect'.

Another person said 'The meals are lovely and very substantial. Everything is lovely here'.

Another person told us that they enjoyed the food and said "The staff are marvellous".

We spoke with two visiting district nurses who were complimentary of the care provided at the home.

We spoke with two members of staff who told us that they enjoyed working at the home. One staff member said that they sometimes found that they had less time than they would like to spend with people but this was not every day.

We found that people who lived at the home received the care they needed. Although some care plans were not easy to follow, they did contain the detail staff needed to support people to meet their needs.

We saw that people enjoyed a varied and nutritious diet and that choices were usually available.

We found that medicines were managed safely.

At the time of our visit there were enough staff to meet the needs of the people who lived at the home. The operations manager agreed to review weekend staffing arrangements to make sure that care was not compromised due to different staffing levels.

Systems were in place to monitor the standards of service and care provided.