Primrose Hill Care Home

Primrose Hill Care Home is a care home providing accommodation, nursing and personal care to older people and people living with dementia in one purpose built building. The service can support up to 60 people. At the time of our assurance visit there were 50 people using the service.

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

An action plan had been put in place in response to areas for improvement being identified following a visit from representatives of the Cambridgeshire & Peterborough Integrated Care System team. However, the action plan had not always been followed to ensure the improvements had been sustained. This had meant that people had not always had their wounds reassessed or dressed as planned. Food and fluid intake records and records for repositioning for those at risk of pressure ulcers had not always been updated by staff to demonstrate the care and support given. These records were also not reviewed by staff each day as required by the services action plan to ensure people were receiving the support they required.

People told us they felt safe living at Primrose Hill Care Home. Staffing levels had recently increased in response to a visit carried out by representatives of the Cambridgeshire & Peterborough Integrated Care System team. Staff told us that the increased staffing levels meant that they could spend more time with people. People received their medicines as expected. The prevention and control of infection was managed safely and in line with government guidance. Staff had been recruited safely and understood their responsibilities to keep people safe.

The registered manager was committed to addressing shortfalls identified during the inspection visit and driving forward improvements.

People were supported to have 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.

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 (report published 02 September 2019).

Why we inspected

We received concerns in relation to people’s safety and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement based on the findings of this inspection. The registered manager took action during the inspection to ensure risk assessments and care plans were updated as necessary.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified a breach in relation to actions within the services action plan were not always followed to check care and support was being carried out as expected. This would ensure people’s needs were met in a timely manner.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Primrose Hill Care Home is a care home providing accommodation, nursing and personal care to older people and people living with dementia in one adapted building. The service can support up to 60 people. At the time of our assurance visit there were 51 people using the service.

We found the following examples of good infection prevention and control (IPC) practice.

The service had processes in place for essential visitors such as virtual meetings with family members and health care professionals or physical visits for people in receipt of end of life care. Checks were in place prior to any visitor entering the building including a temperature check and a health risk assessment. Staff wore full personal protective equipment (PPE) and worked in individual groups and this helped keep people safe. Visits to people were based on individual circumstances. This helped mitigate the risk of cross contamination or spreading infections.

Changes to the layout of the premises including strategically placed furniture, increased social distancing and this helped promote good hygiene practise. Swift and effective actions were taken if people or staff tested positive for COVID-19. Individual risk assessments were in place for any person or staff member at an increased risk of infections.

Audits and governance were effective in ensuring the premises were clean, odour and clutter free. Learning from the early days of the pandemic had been implemented including the process to admit people from home or other care settings. Any contaminated waste was disposed of safely.

Primrose Hill Care Home is a residential care home providing personal and nursing care to 51 people older people and people living with dementia at the time of the inspection. The service can support up to 60 people in one adapted building across three floors. One of the floors specialises in providing nursing care to people living with dementia.

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

Medicines were not always safely managed, as staff did not always follow the providers safe working practices when administering medicines. Lessons were learnt, and actions were taken to reduce the risk of recurrence when things went wrong

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.

People felt safe having their care and support provided by staff at the service. Risk assessments were in place to identify possible risks to people`s health and well-being and to guide staff on how to reduce these risks. Staff worked in conjunction with guidance from external health and social care professionals across different organisations to help promote people’s well-being.

Staffing levels were looked at to make sure they were satisfactory to meet the needs of the people using the service.

Staff knew the people they supported well and how the person wished to be cared for. To develop their skills and knowledge staff received training, competency checks, supervisions and appraisals. People were supported to maintain their independence wherever possible. Staff encouraged people with their food and drink intake.

Staff promoted and maintained people’s privacy and dignity. People had developed good relationships with staff who understood their individual needs and preferences.

People and their relatives told us staff were kind and caring. People`s personal information was kept confidential. People and their relatives were involved in discussions about their care. People’s relatives told us when they had to raise any suggestions or concerns, they were listened to and the concern resolved where possible.

People and staff told us the service was well managed. People and their relatives were asked to feedback on the quality of the service. Most staff felt well-supported. Audits including organisational reviews were carried out to monitor the service and address any improvements required. The registered manager notified the CQC of incidents that they were legally obliged to.

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 requires improvement (published 4 September 2018).

Why we inspected

This was a planned inspection based on the previous rating. The inspection was also prompted in part due to concerns received about end of life care. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the responsive section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Primrose Hill Care 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.

The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well-led.

Primrose Hill Care Home provides accommodation, nursing and personal care for up to 60 older people, some of whom may live with dementia. There were 47 people living at the home at the time of our inspection visit on 24 July 2018. Primrose Hill Care Home 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.

At the last inspection, the service was rated 'Good' overall with requires improvement in responsive. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Primrose Hill Care Home on our website at www.cqc.org.uk.

At this focussed inspection we found the area of Safe required improvement and Well-led remained Good, the service is now rated Requires Improvement overall.

Medicine management needed improvement to ensure that medicines were kept at the correct temperature to ensure their effectiveness at all times.

Individual risks although had been identified there was not always sufficient guidance to ensure staff could effectively manage those people whose behaviour may challenge themselves or others.

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 provider and registered manager had taken steps to improve recruitment and retention of staff and staffing levels had increased. Robust recruitment procedures helped to ensure the suitability of new staff. Training for staff was planned and monitored to ensure staff acquired and updated the skills they needed for the role.

People were protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager or the provider.

The registered manager checked staff's suitability for their role before they started working at the home and made sure there were enough skilled staff to support people safely and effectively.

Risks to people's individual health and wellbeing were identified and care was planned to minimise the risks. Improvements were being made to medicines management to ensure that medicines would be stored consistently at the correct temperature.

The provider and registered manager regularly checked the premises and equipment to ensure they were safe for people to use.

People and their relatives were encouraged to share their opinions about the quality of the service, through surveys and meetings.

The provider's quality monitoring system included regular reviews of people's care plans and checks on medicines management and staff's practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of re-occurrence.

Further information is in the detailed findings below.

This comprehensive inspection took place on 9 January 2017 and was unannounced.

The provider is required to have a registered manager as one of their conditions of registration. A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the CQC to manage the home. 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 Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS.

People told us they felt safe. Risk assessments were in place which gave staff the information they needed to minimise risks to people. Staff had an understanding of how to protect people from harm and knew what action they were to take if they had any concerns.

Staffing levels ensured that people received the support to meet their needs. There was an increase in the number of house-keeping staff to improve the hygiene and cleanliness of the sluice areas of the home. New staff were being recruited to fill vacancies. The recruitment practices protected people from being cared for by staff that were unsuitable to work at the home. Staff received the training and support they required to carry out their role.

Staff were kind and caring to people who they looked after. However, staff needed to take advantage of opportunities presented to them to improve the quality of their engagement with people. That said, they knew people well and were aware of their preferences, likes and dislikes. People’s privacy, independence and dignity were upheld.

People were supported to take their medicines as prescribed. Records showed that medicines were administered as prescribed. People were helped to keep well because people were had access to healthcare services when needed. People’s nutritional health was maintained: they had enough to eat and drink and nutritional supplements were provided for those people who were at risk of undernourishment.

Pre-admission assessments were carried out with the involvement of people and people who were important to them. People were actively consulted about their day-to-day care. However, there was a lack of evidence that there was a more formal system in place to review people’s care with their involvement. Activities were provided in communal areas and trips out were organised for those people who wanted to take part. However, there were times when there was a reliance on music or television to engage people in a more meaningful way. Work was in progress to improve the quality of people’s recreational activities to maintain and promote their sense of well-being.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the manager if they needed to.

People knew who the registered manager was and they were provided with opportunities to make suggestions about how they wanted the home to run. The registered manager ensured that the staff team were supported and had the right amount of information to do their job. In addition, there were opportunities for staff to provide feedback about any improvements that could be made, although they were unable to give examples of these. Audits were carried out with increased supervision of staff to ensure that the safety and quality of people’s care was maintained.

Below is a summary of what we found.

If you wish to see the evidence that supports our summary please read the full report.

Is the service safe?

Staff told us that they enjoyed their work and we found they were appropriately trained. Staff we spoke with demonstrated they understood the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards so that people who could not make decisions for themselves were protected.

On the whole, Primrose Hill Care Home was visibly clean and tidy. It was evident that staff understood their responsibilities with regard to infection control. The provider told us that the carpets would be replaced in parts of the home over the next few months.

Is the service effective?

We observed good relationships between staff and people who used the service. Staff we spoke with demonstrated they understood how to meet people's individual needs. Care plans were up to date and provided detailed information on how people wished to be supported.

We saw that care was provided in a way that was intended to ensure people's safety and welfare. People told us they liked living at Primrose Hill Care Home. One relative commented, 'My (relative) is well looked after and I have never had any concerns.'

Is the service caring?

We saw that people were supported by staff who were kind and respectful. One person commented, 'The staff are very kind.' Care records contained information about people's preferences and it was clear that people had been involved in planning their care. One relative told us, 'I can not speak highly enough about the care'.

Is the service responsive?

People and their relatives told us that issues or concerns were dealt with promptly by staff. One relative told us, 'I have had a few concerns but they are always dealt with. I have no complaints at all.' We looked at two recent complaints and found they had been investigated and followed up in line with the complaint's procedure.

We saw that the service worked with a range of health care professionals and ensured people received care in a coherent way. A relative told us, 'I am kept very well informed. When (my relative) went to hospital I was put in the picture.'

Is the service well led?

The provider had a number of systems in place to ensure that the quality of the service was regularly assessed. Monthly quality checks took place and covered a wide range of areas to ensure people received a good service. There was evidence that the provider took action to improve the service when this was required.

People who lived at Primrose Hill Care Home and their relatives were invited to regular meetings and were encouraged to express their views. The provider told us that a questionnaire to ask people and their relatives what they thought about the service was planned for later in the year.

We saw that staff were caring and kind with people and included people whenever they passed and the home atmosphere was calm and relaxed. Staff liked that they worked on a single floor so they could get to know the people there.

The provider may find it useful to note that some carpets in bedrooms and corridors were discoloured and although the home was generally clean and bright there was malodour in some areas.

The provider may find it useful to note that the first aid boxes contained out of date goods such as sterile dressings and CPR face shields. The manager audited these during the inspection.