Priory Court Care Home is owned by St Cloud Care plc. It provides accommodation for 89 older people. The service has specialist reminiscence and neurological disability unit and hydrotherapy facilities. At the time of our inspection 83 people lived here. The home had been adapted to meet people’s mobility needs, such as specialist baths for people who could not mobilise well. Adaptions had also been made to meet the needs of people living with dementia. Doorways were clearly marked and signed, and flooring was free from complex patterns, or shiny surfaces that may confuse people. Although adaptations had been made around the home, it still felt homely.
There was a registered manager in post. 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 inspection took place on 02 March 2016 and was unannounced. At our last inspection in November 2014 we raised a concern about the level of staffing, and had made recommendations around the environment and activities for people. These issues had all been addressed by the provider at the time of this inspection.
There was generally positive feedback about the home and caring nature of staff from people and relatives. One person said, ““Staff are very kind and loving.” However another said, “Staff are not terribly efficient” and felt that the home in general was only “alright.” A relative said, “The staff are fabulous – all of them.”
The staff were kind and caring and treated people with dignity and respect. One person said, “I have been able to make friends with the staff here.” Good interactions were seen throughout the day of our inspection, such as staff holding people’s hands and sitting and talking with them. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.
People were safe at Priory Court Care home. People were overall positive about the levels of staff at the home. Although some felt they had to wait for staff at busy times, they said staff always came when needed. One person said, “I always get attention when I ask and never have to wait long.”
Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.
In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building, in a format people could understand. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.
The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.
People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.
Where people did not have the capacity to understand or consent to a decision the provider had not always followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had not always been completed. Staff’s understanding of the MCA was also limited. The provider had already identified this issue across their homes and an action plan was in place to correct it. Staff were heard to ask people for their permission before they provided care.
Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected, however due to a lack of understanding of the MCA and DoLS, some of the applications may not have been necessary.
Care plans were based around the individual preferences of people as well as their medical needs. People were involved in their care plans. One person said, “There is a section in my care plan which has a page about me. Staff know about me from that.” Care plans gave a good level of detail for staff to reference if they needed to know what support was required. However some documentation, specifically around pressure sore care, was not readily available. Staff did then not have a clear understanding on how often a person should be turned to reduce the risk of pressure sores deteriorating. Feedback from a healthcare professional was positive about the actual care given to people, this highlighted the risk to people from receiving poor care was low. The registered manager had taken action to correct the issue on the day of our inspection.
People had a good choice of food and drink available to them. People received support from staff where a need had been identified. Specialist diets to meet medical or religious or cultural needs were provided where necessary.
People were supported to maintain good health as they had access to relevant healthcare professionals when they needed them. People’s health was seen to improve due to the care and support staff gave. Visiting healthcare professionals were complimentary about the nursing care given at the home.
People had access to activities that met their needs. Some activities were based in the local community giving people access to friends and meeting new people. Activates for people living with dementia also took place and helped to prompt people’s memory and encourage communication. The staff knew the people they cared for as individuals.
People knew how to make a complaint, and the management took appropriate action to try to resolve issues. The policy was readily available to help people and relatives know how to make a complaint if they wished. When complaints had been made, the registered manager took action, such as meeting with the individuals and developing an action plan to try to put things right. Some people felt that this did not always address their concerns. Other people were very happy with the management and how they responded to complaints.
Quality assurance records were kept up to date to show that the provider had checked on important aspects of the management of the home. Records for checks on health and safety, infection control, and internal medicines audits were all up to date. Accident and incident records were kept, and would be analysed and used to improve the care provided to people should they happen.
People had the opportunity to be involved in how the home was managed. Regular house meetings took place to give people a chance to have their say. Summing up their experience of living at Priory court Care Home, one person said, “This is one of the best, brightest and friendliest homes I have lived in. It’s not great, but it is good.”