Archived: Priory Mews Care Home

Priory Mews Care Home is registered to provide support to up to 156 people. At the time of the inspection there were 103 people living in the service. Priory Mews is arranged across five separate buildings, called communities. Cressenor has capacity for 42 people and provides residential care for people living with dementia. Mountenay and Marchall have capacity for 30 and 23 people respectively and provide nursing care for people living with dementia. Beaumont and Berkeley have capacity for 30 and 15 people respectively and provide nursing care for older people. A separate building houses the management and administration offices, kitchen, reception and training facilities.

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

People told us they felt safe in the service. One relative said, “Yes I feel she is very safe; her hand is the main concern at the moment, they are dealing with that well and they are keeping me updated with the progress”. People were safeguarded from the risk of abuse and received safe care and treatment. There were enough staff to meet peoples’ needs. Medicines were managed in line with national guidance. Lessons were learned when things went wrong.

People and their relatives were involved in decisions about their care and they received care which promoted their dignity and independence. One relative said, “They always ring me, with his medication I am always consulted”.

Quality assurance processes were in place to monitor the service. The managers promoted an open-door policy and staff told us that they felt listened to and were confident that action would be taken if they raised concerns.

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.

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 requires improvement (published 30 April 2020) and there were three breaches of regulation. 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.

Why we inspected

We carried out an unannounced comprehensive inspection on this service on 25 and 26 February 2020. Breaches of regulation 10, 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Caring and Well-led which contain those requirements.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Priory Mews Care Home is registered to provide support to up to 156 people. At the time of the inspection 126 people were living in the home. Priory Mews is arranged across five separate buildings called communities. Cressenor has capacity for 42 people and provides residential care for people living with dementia. Mountenay and Marchall communities provide nursing care to people with dementia and have capacity for 30 and 23 people respectively. Beaumont and Berkeley provide nursing care for 30 and 15 people respectively. There is a separate building housing administration offices, kitchen, reception and training facilities.

People’s experience of using this service

People’s experience of care was affected by staff not being effectively deployed. This meant they had a poor mealtime experience, and did not have many opportunities for engagement with staff. People’s dignity was not always maintained. People were supported by staff who had not always had the training they needed to perform their roles. There were inconsistencies in the level of detail about people’s medicines which meant we were not assured that medicines were always managed in a safe way.

The risks faced by people in receipt of care had been assessed but there was significant variation in the quality of risk assessments. This was similar with people’s care plans and records of care. People had been asked for their views but the level of detail in care plans varied which meant there were risks that people would not always get support in the way they wanted.

People were supported by staff who were knowledgeable about the different types of abuse people may be vulnerable to and knew how to report any concerns about people being abused. We saw incidents and allegations were recorded and investigated appropriately.

People told us and records confirmed staff knew how to support them with their healthcare needs, including their oral healthcare needs. We saw any concerns about people’s health were appropriately escalated. People’s care was reviewed regularly but issues with record keeping meant it was not always possible to tell if people had been supported in line with their preferences. There were inconsistencies in the level of detail about people’s preferences across the different communities, including whether people’s non-clinical preferences at the end of their lives had been considered.

People were not always supported to have maximum choice and control of their lives as staff did not consistently demonstrate they were working within the principles of the Mental Capacity Act (2005) and in people’s best interests. People’s consent to care was not always recorded.

People knew how to make complaints and we saw complaints were investigated and responded to in an appropriate manner. The provider sought feedback from people and their families in a variety of ways and acted upon the feedback received.

The provider and the registered manager were aware of, and working to address, the issues with the quality and safety of the service. The quality assurance systems in place had identified the issues with the quality and safety of the service. There was a comprehensive, robust and realistic plan in place to address the concerns. The registered manager and provider were open and transparent throughout the inspection and demonstrated they were looking to continuously learn and make improvements.

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 8 March 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines management, staff deployment and training and dignity of people receiving care at this inspection.

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 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.

The service can accommodate up to 156 people. At the time of the inspection there were 136 people living at Priory Mews Care Home. The service comprises of five separate units adjacent to each other. Beaumont and Berkeley provide residential and nursing care for 30 and 14 people respectively; Marchall and Mountenay provide care for people with nursing dementia needs for 22 and 29 people respectively; and Cressenor House cares for 41 people with residential dementia requirements. A separate house accommodates the main reception, the kitchen, the senior management team, and the administration team.

The inspection was unannounced and took place on 10 and 11 January 2019.

The service was run by a registered manager and they were present on both days of the inspection visit. 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.

At the last inspection on 6 and 7 November 2017, the overall rating of the service was ‘Requires Improvement’. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always minimised nor significant events safely responded to. Checks on the quality of the service were not sufficient to make necessary improvements. People were not always given their medicines as directed by their doctor. People were not always supported appropriately at mealtimes or treated with dignity. We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulations and said that this would be completed by 30 April 2018.

We also made four recommendations. These were about making sure there were enough staff available; the control of infections, adaptations to the environment and the range of activities available.

At this inspection, we found that that potential risks were assessed and managed to help keep people safe. Accidents and incidents were monitored, and lessons learned for the benefit of people. People were consistently treated with dignity and got the help they needed at mealtimes. There had been improvements to record keeping. However, shortfalls in the management of medicines remained as it could not be assured that everyone received their medicines as prescribed by their doctor. There were a number of discrepancies in medicines records including the use of ‘only when needed’ medicines prescribed for people with agitation.

This is the second time that the service has been rated as Requires Improvement.

The provider had addressed all good practice recommendations. Staffing levels were assessed and monitored to make sure there were enough staff deployed in each unit. Infection control practices minimised the spread of any infection. This included making sure each person who used a hoist had their own sling to prevent cross contamination. Changes had been made to the environment through a use of visual aids and decoration to help people living with dementia make sense of their surroundings. The activity team had been expanded so there were activity leads in each unit to undertake group and one to one activities with people to help improve their well-being.

Systems to monitor the quality of care had been strengthened but had not identified the shortfalls in the management of medicines.

A consistent staff practice had developed throughout the service whereby everyone was treated as an individual. People were treated with dignity and respected. People and their relatives told us staff were kind and caring and made people feel safe.

Staff received the training they needed to enable them to support people with a range of needs. Staff were suitably trained, received regular supervisions and felt well supported. The provider made sure the registered nurses had access to the training required to ensure their continuous professional development.

Health and safety checks helped make sure that the environment was safe and that equipment was in good working order. Recruitment practices were robust in ensuring only suitable staff were employed at the service.

People were supported to access health care services when needed. The provider worked in partnership with a range of healthcare professionals to ensure people received appropriate care and treatment. People had sufficient food and drink and were provided with choices and at mealtimes.

People were supported to have maximum choice and control of their lives in line with the principles of the Mental Capacity Act 2005. The provider had taken the necessary steps to ensure that people only received lawful care that was the least restrictive possible.

People's needs were assessed and people and their family members were involved in developing and reviewing care plans, which included people’s choices and preferences.

People were supported at the end of their life to have a comfortable, dignified and pain-free death.

Feedback from people and their relatives was regularly sought and acted on so that the service improved for their benefit. People felt confident to raise any concern or complaint.

Records had improved so they were accurate and accessible which meant that appropriate guidance was available to staff.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Priory Mews 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. The service comprises of five separate units adjacent to each other. Beaumont and Berkeley provide residential and nursing care for 30 and 15 people respectively; Marchall and Mountenay provide care for people with nursing dementia needs for 23 and 30 people respectively; and for Cressenor House cares for 42 people with residential dementia requirements. A separate house accommodates the main reception, the kitchen, the senior management team, and the administration team. There were 137 people living in Priory Mews at the time of our visit.

The service was run by a registered manager and they were present on the days of our visit. 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.

This is the first time the service has been rated Requires Improvement.

People and their relatives told us staff were kind and caring and made people feel safe. They said staff had the necessary skills to respond to people’s needs, monitored their health and that people enjoyed their meals. However, we found inconsistency in care practices across the service which meant that people did not always receive the level of care expected.

Systems to monitor the quality of care were not effective. Staff did not always follow guidance or escalate concerns in relation to potential risks to keep people safe. Accidents and incidents were not suitably monitored to make sure that actions taken were effective. Records were not always accurate or accessible which could result in them receiving inappropriate staff support.

Staff who administered medicines had been trained in how to do so, but there were not safe systems in place for the management of medicines.

There was inconsistency in staff practice which meant that people’s dignity was not always respected and people were not always given the support they required at mealtimes.

We have made recommendations about the deployment of staff to ensure they are available in suitable number; and infection control practices; the design of the service to meet the needs of people living with dementia and the activity programme.

Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Recruitment practices were robust in ensuring only suitable staff were employed at the service.

People’s health needs were assessed and monitored and the service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment.

Shortfalls had been identified in staff training and plans were in place to ensure they received relevant training for their role. Staff felt well supported both informally and through formal processes such as staff meetings and supervisions.

Staff sought and received people's consent to the support they provided and in line with the principles of the Mental Capacity Act 2005. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The service had made DoLS applications, to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so.

People’s needs were assessed and a plan of care was developed which included their choices and preferences. Guidance was in place for staff to follow to meet people’s needs.

The views of people and their relatives were sought through meetings and an annual survey.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.