Priors House

Priors House is a residential care home providing personal and nursing care for up to 80 people, including people living with dementia. At the time of our inspection there were 62 people using the service. Priors House consists of 4 separate suites over 2 floors which are separated for people who have nursing needs. There are shared lounges and dining rooms across both floors and a café area in reception.

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

Staff were passionate about working at Priors House and were proud of supporting people to have a good quality of life. Care was person centred and opportunities to help people create new memories were valued and encouraged. Many staff had worked at Priors House for a long time and there was an inclusive culture where everybody was valued. Quality and safety within the home was monitored through regular audits with action plans created to drive improvements and there was a strong culture of learning from incidents. People, relatives, staff and professionals had opportunities to engage and provide feedback on the service. Priors House worked in partnership with health professionals and other organisations to improve people’s outcomes and staff had varied opportunities to progress their career. Links were developed with the local community through the provision of dementia awareness raising events and partnerships with a local secondary school.

Staff were trained in recognising and reporting safeguarding concerns and were confident speaking up. People felt safe living at Priors House. Risks around people’s clinical needs were assessed and identified and guidance for staff was included in people's care plans. There were enough staff to meet people’s needs and staff were recruited safely. Medicines were managed safely and people received their medicines as prescribed. We were assured by infection control practices and there were no restrictions on visiting. Lessons were learned following incidents in the home and shared with the staff team.

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. Staff understood how to promote choice for people. People’s needs were assessed before they moved to Priors House. Staff had the knowledge and skills to support people effectively and safely and feedback from people and staff supported this. We received consistently positive feedback about people’s enjoyment of their food and people with specialised diets were supported safely and their nutritional intake was monitored. There was effective communication both internally at Priors House and with external health professionals. Weekly ward rounds ensured people’s health and wellbeing was checked regularly by a GP and frailty nurse and people were referred to other health professionals when they needed to be. People were encouraged to decorate and furnish their rooms to reflect their life and interests.

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 (published 17 December 2019).

Why we inspected

We received concerns about repositioning for people with skin damage and topical creams with concerns that records were completed without the care being provided. It was also prompted due to concerns regarding manual handling and dementia care. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective and well-led sections of this full report.

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 outstanding based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Priors House is registered to provide accommodation, nursing and personal care for up to 80 older people, including people living with dementia. At the time of our inspection visit there were 62 people living at the home. Care is provided across two floors. Each floor had two units, each with its own communal lounge and dining room. Ground floor units provided residential and dementia care. First floor units provided nursing care. Everyone’s bedrooms were en-suite and each unit had communal bathroom facilities.

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

The registered manager and staff team understood the importance of promoting lifestyle opportunities, events and activities that are specifically tailored to people’s needs, aspirations and life experiences. The management and staff continually reviewed and improved ways of linking in with local connections. They understood how family values were important to those in their care. This approach continued through providing end of life care which remained respectful and sensitive to people’s and families wishes. An annual memorial had been introduced to remember and celebrate people who used to live at the home which we were told, gave relatives comfort and helped them remember times of happiness. Community links included health care professionals which continued to be developed which helped support good outcomes for people.

People told us they felt safe living at Priors House. Staff knew how to protect people from poor and abusive practice. Safe staffing levels across the home ensured people received support when needed. Agency staff use continued to be used to support permanent staff whilst plans for recruitment continued. Staff followed safe principles for infection control and their training and practice meant the potential of cross infection were kept to a minimum. People received their medicines safely from trained staff. However, we have made a recommendation about the management of some medicines.

Staff were confident in their abilities because their training and development needs were supported by the provider. Staff training included refresher training alongside an induction for new staff. One to one supervision meetings; observed practice and regular staff meetings gave staff the opportunity to share feedback and to discuss development opportunities.

People told us staff were kind, caring and respectful in how they lived their lives and, in the choices, they made. People said management were effective; they listened and acted on feedback to help drive standards within the home. People had individual care plans and assessments that met their health and social needs. People were supported by nursing and care staff and on occasions, other health care professionals were involved to maintain their health and wellbeing.

The management team remained consistent and they demonstrated a good understanding of their managerial responsibilities to ensure people received care to the standards people expected. The majority of people gave us positive feedback about the service and felt comfortable raising concerns knowing they would be dealt with. A programme of local and provider audits and checks made sure actions were taken when improvements where identified. However, we found one continuing theme identified in the provider’s audits which the registered manager assured us they would address promptly.

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 Good (published 19 May 2017).

Why we inspected

This was a planned inspection based on the previous rating

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

Priors House is a purpose built nursing home which provides care over two floors to people including people who are living with dementia and people who have a physical or mental disability. Priors House is registered to provide care for 80 people. At the time of our inspection visit there were 70 people living at the home. On the ground floor, residential and dementia care was provided. People living on the first floor received residential and nursing care.

Priors House was last inspected in May 2016 and was rated as ‘requires improvement’. We returned to check if required improvements had been made to the responsiveness of staff to meet people’s needs and to the governance and management of the home. At this inspection, we found improvements had been made.

There was a registered manager at the home. 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 and relatives gave positive comments about the care and support they received. People received care that enabled them to live their lives as they wanted and people were supported to remain as independent as possible. People were encouraged to make their own decisions where possible and care was given in line with their expressed wishes. People were supported to maintain relationships and keep in touch with those people who were important to them.

Care plans were detailed and contained accurate and up to date relevant information for staff to help them provide the individual care people required. People and relatives were involved in making care decisions and reviewing their care to ensure it continued to meet their needs.

Where people were assessed of being at risk, care records included information for staff so risks to people’s health and welfare were minimised. Staff had a good knowledge of people’s needs and abilities which meant they provided safe and effective care. Staff received essential training to meet people’s individual needs, and effectively used their skills, knowledge and experience to support people and develop trusting relationships.

People’s care and support was provided by a trained and caring staff team and there were enough available staff to be responsive to meet their needs. People told us they felt safe living at Priors House and relatives were confident their family members received safe care and treatment. Staff knew how to keep people safe from the risk of abuse. Staff understood what actions they needed to take if they had any concerns for people's wellbeing or safety.

The registered manager and care staff understood their responsibilities in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). Where people lacked capacity, staff’s knowledge and people’s records ensured people received consistent support when they were involved in making complex decisions, such as decisions around their personal safety or where they wanted to live. People said staff gained people’s consent before they provided care and supported people to retain as much independence as possible.

People were supported to pursue various hobbies and leisure activities and people had a variety of activities to interest them. The registered manager wanted to further develop the activities programme to ensure people’s stimulus was maintained.

People had meals and drinks that met their individual requirements. People received support from staff when they required it, and anyone at risk of malnutrition or dehydration, were monitored.

People knew how to raise concerns or complaints if they needed to. Information in the home advised them how to raise complaints and expected timescales and action.

People and relatives feedback was sought by completing provider surveys and regular attendance at meetings held in the home. The registered manager told us they had an ‘open door’ for anyone who needed to see them.

Priors House is a nursing home which provides care to older people, people living with dementia and young people with physical disabilities. Priors House is registered to provide nursing care for up to 80 people. At the time of our inspection vist there were 66 people living at the home. The home provides care and support across two floors, divided into four suites. The ground floor provides residential care (Jephson suite) and care to people living with dementia (Telford suite). The first floor provides residential care (Victoria suite) and nursing care (Beaufort suite).

There was a registered manager in post. The previous registered manager left the service in January 2016 and the new registered manager had been appointed in March 2016. 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 service has not previously been inspected so it was it’s first inspection since being registered.

Staff knew how to keep people safe from the risk of abuse. People told us they felt safe living at Priors House and relatives agreed their family members felt safe and protected from abuse or poor practice.

The provider assessed risks to people’s health and welfare and wrote care plans that minimised the identified risks. However, some care records and risk assessments required additional information to make sure staff provided consistent support that met people’s needs.

There were enough staff on duty to meet people’s health needs. The provider relied on agency staff to support existing staff and people sometimes felt on occasions they did not have continuity of care from an established staff team.

People’s medicines were managed, stored and administered safely in line with GP and pharmacist prescription instructions.

People were cared for by kind and compassionate staff, who knew their individual preferences for care and their likes and dislikes. Staff understood people’s needs and abilities and they received updated information at shift handovers to ensure the care they provided, supported people’s needs. Staff received training that was essential to support people’s needs. Staff felt they had the right skills and knowledge to support people safely and effectively.

Nursing and care staff supported and promoted people’s choice and understood their responsibilities to comply with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Records showed consideration had been made if a persons’ liberty may be deprived, as the provider had made applications to the local authority. However, there were inconsistent records for some people who lacked capacity and where they needed encouragement with those decisions to ensure decisions were taken in their best interests.

People were offered meals that were suitable for their individual dietary needs and personal preferences. People were supported to eat and drink according to their needs, which minimised risks of malnutrition. Staff ensured people obtained advice and support from other health professionals to maintain their health.

Care was planned to meet people’s individual needs and abilities and care plans were reviewed although some information required updating to ensure staff had the necessary information to support people as their needs changed. People were supported to pursue their interests and hobbies and live their lives how they wished, and staff supported people to remain as independent as possible.

The quality monitoring system included reviews of people’s care plans and checks on medicines management, but some of those reviews did not identify the issues we found. Accidents, incidents and falls were investigated by the provider and actions taken to minimise the risks of a re-occurrence. Improvements were required in monitoring people whose health conditions posed risks to them and the management and deployment of staff, to ensure safe levels of care were maintained to a standard that supported people’s welfare.