Primroses Home

About the service

Primroses Home is a care home registered to accommodate and support up to 3 people with learning disabilities, autistic people and people with mental health needs. At the time of the inspection, 3 people were living at the home. People living in the home had their own bedrooms and there were shared communal spaces, including lounges, a kitchen and a garden area.

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

The provider did not ensure they had robust systems in place to manage medicines. We saw 2 people were prescribed medicines on a when required basis (PRN). There not appropriate protocols in place to advise staff on what circumstances and how to give these medicines. This meant staff did not have the information to tell them when someone may need the medicine or how much to give. The provider’s quality assurance systems had failed to identify the issues we found in respect of medicines management.

Following the inspection, the provider sent us evidence to indicate they had made changes to improve medicines management.

Right Support:

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 home supported this practice. Staff were committed to supporting people in line with their preferences and supported people to receive their medicines safely and as prescribed.

People were supported to access healthcare services to promote their wellbeing and help them to live healthy lives. Staff managed risks to minimise restrictions, focusing on what people could do for themselves.

The home had effective infection, prevention and control measures to keep people safe, including good arrangements for keeping the premises clean and hygienic.

Right Care:

People received person centred care. Staff understood how to protect people from poor care and abuse. Staff had received training on how to recognise and report abuse and they knew how to apply it. People's care, treatment and support plans reflected their range of needs and staff knew people's needs well.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. Safe recruitment processes were followed. People received their medicines as prescribed. People were able to express their views and make decisions about their care. Staff ensured people's privacy and dignity was respected and their independence promoted.

Right Culture:

There was a positive culture at the service and people benefited from being supported by happy staff which was reflected in the atmosphere at the service. The management team worked directly with people and led by example. Staff told us they enjoyed their job and making a positive difference to someone's life.

Learning from incidents and concerns was used to improve staff practice in caring and supporting people. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 25 July 2018).

Why we inspected

This was a planned inspection based on when the home was previously inspected.

This was a focused inspection and the report only covers our findings in relation to the key questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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 COVID-19 and other infection outbreaks effectively.

We undertook this inspection to assess that the service is applying the principles of right support right care, right culture.

The overall rating for this service has now changed from good to requires improvement. We have made a recommendation to follow best practice guidance around quality assurance.

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.

We inspected the service on 06 June 2018 and this was their first inspection since they registered with the Care Quality Commission (CQC).

The service had a registered manager. 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.

Safeguarding procedures were in place and staff demonstrated a clear understanding of what abuse was and how to safely report any concerns. The service had detailed, person centred care plans and risk assessments in place to guide staff to best support people using the service, including their skin management and personal care plans. A recommendation was made to include more detail about people’s mental health to ensure staff were understanding of how best to support people receiving support and manage risk.

Pre-employment checks had been carried out to ensure staff were suitable to support vulnerable adults and staffing levels were sufficient, which allowed the service to meet people’s needs. Medicines were managed safely. A recommendation was made about record keeping to ensure staff could safely audit people’s medicines. Infection control was being managed in a safe way and staff were provided with personal protective equipment to prevent the spread of cross infection.

The service completed pre-assessments to gather information about people’s needs and ensure it was able to meet those needs. Records and observations showed that the staff worked in a person-centred way and there was clear evidence of organisations working together to deliver safe and effective care. People had choices around their meals. A weekly menu was prepared with people and they could review this each day. There was evidence of healthy food on the menu and in the fridge.

Records confirmed that staff had completed training and received an induction to allow them to provide high quality support. A recommendation was made to ensure all staff had completed training specifically on mental health to ensure they could support the people receiving care in line with best practice.

Staff understood the Mental Capacity Act 2005 (MCA). MCA is law protecting people who are unable to make decisions for themselves. People who had capacity to consent to their care had signed their care plans and risk assessments and where consent was not applicable, the appropriate authorisation procedures had been completing following a recommendation. These are referred to as the Deprivation of Liberty Safeguards (DoLS).

Staff were observed to deliver personalised care to people and demonstrated an understanding of their individual needs. Records were written in a person-centred way and detailed people’s individual preferences and support needs. All people received a welcome booklet that gave information about the service, what to expect and who they could talk to about any concerns.

The service was due to run weekly forums for people to feedback about the service. People were observed to be able to approach staff at any time for emotional and practical support and staff were seen to be caring. Advocacy services were available to help people have their views and wishes heard. Staff demonstrated an understanding around equality and diversity and how to maintain people’s privacy, dignity and independence. Records were treated confidentially and stored securely and care plans evidenced people were involved in decision making around their own care and support package.

The service had a complaints procedure in place and complaints had been fully investigated and actioned. People were informed of the complaints procedure in the welcome booklet they received. People were able to engage in activities of their choice, for example reading and watching television.

Staff spoke positively about the registered manager and there were auditing tools in place to monitor the running of the service and gather feedback to ensure the service could continue to learn and improve. The provider supported the team by working shifts as well as being available as part of an ‘on call’ service.