Primecare

Primecare is a residential care home providing personal care to up to 41 people aged 65 and over. At the time of the inspection, 26 people were using the service.

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

People were being cared for safely. All risk assessments were currently being updated onto an electronic care planning system and the new registered manager was on target to complete this. Staff knew people very well.

Systems were now in place to monitor accidents and incidents and ensure safeguarding concerns were referred in a timely manner. Learning lessons from these to reduce the risks of issues occurring again were discussed with staff. There were enough staff deployed at the time of the inspection to meet people's needs. We observed positive interactions between staff and people. Staff worked as a team to meet people's needs. People's medicines were well managed.

Prior to people moving into the service their needs were assessed. These assessments were used to develop the person's care plans. People enjoyed a varied and nutritious diet. Staff worked with external professionals to promote people’s health and wellbeing. Improvements had been made to the environment; however, we have made a recommendation about supportive environments for people living with dementia. 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.

A new manager had just started at the service and staff were positive about their appointment. Following the inspection, the manager was registered with CQC. The provider and the management team carried out the appropriate checks to ensure the quality of the service was continuously moving forward.

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 22 October 2020) and there were 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 undertook this focused inspection to check the provider 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, effective and well-led which contain those requirements.

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 Primecare on our website at www.cqc.org.uk.

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.

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.

We found the following examples of good practice.

The provider had created a safe and dedicated visiting hub to enable people to see and speak to their friends and relatives. The room had a divider screen, and separate external doors for visitors and people that used the service. The room was well-ventilated and cleaned between visits.

Staff had all completed infection prevention and control training and this included the correct procedures for using PPE.

As part of full infection control measures, laundry and waste arrangements had been correctly implemented to reduce the spread of infection. The service had created a separate area for clean laundry.

The service was clean throughout. There were appropriate procedures to ensure infection control risks were minimised. Seating in the lounge and dining area reflected social distancing guidance. The registered manager told us, "I am proud of what we have achieved since the last inspection."

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

At the inspection we found the service did not have effective arrangements in place to identify and manage risks appropriately to support people to stay safe and protect them from harm. People at risk of falls did not always have the equipment they needed, and safety concerns were not always identified or acted upon.

Individual care plans were in place, but these were not always reflective of people’s needs and how risks should be managed. People were not being repositioned in line with their care plan.

Staff had access to Personal Protective Equipment (PPE) and were subject to regular testing to identify if they were symptomatic or had contracted COVID 19. However, we were not assured the provider was doing all that was practical to ensure COVID 19 outbreaks could be prevented. The service was not consistently following the government guidance, about how to operate safely during the COVID 19 pandemic, in areas such as the wearing of masks, handwashing and social distancing.

Safeguarding procedures were not fully understood and incidents escalated by the management team.

Staff told us there were sufficient staff to meet people’s needs and they were supported by the management team. There was a lack of social activities taking place and the registered manager told us they were recruiting to this role. Relatives told us individual staff were helpful.

We found shortfalls in the way the service was led, and governance arrangements did not ensure the delivery of quality and safe care. Audits did not identify the shortfalls found as part of this inspection and there was no effective improvement plan in place to drive improvements and change.

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 6 December 2019).

The service remains rated requires improvement. This is the second consecutive inspection where the service has been rated Requires Improvement.

Why we inspected

The inspection was prompted in part due to concerns received about areas of concern including medicines, the oversight of risk, staffing and the management of the service. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

We have found evidence that the provider needs to make improvements.

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 Primecare on our website at www.cqc.org.uk.

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.

Primecare is a residential care home providing personal care to up to 41 people aged 65 and over. At the time of the inspection, 33 people were using the service.

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

People told us they felt safe and the staff knew how to recognise and report any suspicions of abuse. Some people’s risk assessments did not have enough information. Medicine systems needed to improve, and some staff required additional training.

The service was in the process of moving from paper to electronic care recording. Consequently, information was held in several different places and was not always consistent and did not always reflect people’s needs.

Some improvements were needed to ensure information was reflective of professionals' involvement. The registered manager needed to develop links with the local dental service, to ensure people's oral health care needs could be met. We have made a recommendation about oral health care.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice.

People enjoyed the food and were supported to eat in a safe way. There was enough staff to meet people’s assessed needs.

The quality of the service was monitored, and a range of audits had been completed. However, they had failed to identify the improvements the inspection identified. The registered manager gathered people’s views and used this information to look at ways they could improve the service.

Staff were kind and caring toward people’s needs. People were encouraged to take part in stimulating and meaningful activities.

People and their family members, and visitors were encouraged to make comments, complaints, or compliments about the service.

Rating at last inspection: The last rating for this service was Good (26 April 2017)

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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 Primecare on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in regulation in relation to Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 12: Safe care and treatment (a) (g) This is because robust systems were not in place to assess the risks to the health and safety of service users when receiving care or treatment. The proper and safe management of medicines needed to be improved.

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 the 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 registered manager was present during our inspection. 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.

There were enough staff to meet the needs of people who used the service. People were supported to have maximum choice and control over their lives and staff cared for people in the least restrictive way possible.

Staff understood how to keep people safe and could describe the correct steps they would take if they were concerned that abuse had taken place. Accidents and incidents were appropriately recorded and investigated and risk assessments were in place for people who used the service.

The registered manager and staff involved people to make decisions about the service. People told us that staff understood their needs and preferences, and they received effective care and support from well-trained staff.

Staff had developed caring relationships with the people they supported. Family members told us that there was a positive atmosphere and people were encouraged to take part in activities that they wanted to pursue. A wide range of activities were on offer to people.

Medicines were managed safely and staff members understood their responsibilities. The registered manager undertook regular audits and improvements were carried out when these were needed. The quality of the service was monitored and assessed continuously.

People who used the service, family members, and visitors were encouraged to make comments, complaints, or compliments about the service. Further information is in the detailed findings below.