Primrose Lodge Care Home

Updated 9 January 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. We also sought advice from a CQC medicines inspector about our findings in relation to medicines management.

Service and service type

Primrose Lodge Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Primrose Lodge Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We also contacted Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people, 4 relatives, 15 staff including the regional operations manager, registered manager, deputy manager, agency nurse, care home assistant practitioner, senior and care staff, activities coordinator, chefs and kitchen staff, domestic and maintenance staff. We also spoke with 3 health professionals and 2 staff from Healthwatch who were visiting the home. We asked the registered manager to message all staff to ask for any feedback to be sent to us. We did not receive any further feedback.

We looked at a range of records relating to people, staff and the management of the service.

Updated 9 January 2024

About the service

Primrose Lodge Care Home is a purpose-built residential care home providing accommodation and nursing and personal care to up to 48 people. The service provides support to younger adults, those with a physical disability and people over the age of 65, including those living with dementia. At the time of our inspection there were 38 people using the service.

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

Medicines were not managed safely. Records did not always demonstrate that medicines were administered as prescribed. There were inconsistencies and shortfalls in relation to medication stock counts, the recording of allergies, medicated patch application and ‘when required’ medicines guidance.

An effective system was not fully in place to assess people’s dependency and staffing levels. People, relatives, staff and professionals told us that there was not always enough staff to provide person centred care. We observed that care was sometimes task focused rather than person centred.

The provider had not ensured they were displaying their CQC rating on their website in line with legal requirements.

Improvements had been taken since our last inspection in relation to infection control. The home was clean and staff had access to and used PPE in line with government guidance.

People were supported to eat and drink enough to maintain their health and wellbeing. However, mealtimes were sometimes task orientated rather than person-centred. We have made a recommendation about this.

The décor of the home did not fully meet the needs of people living with dementia. There was limited signage to help orientate people. We have made a recommendation about this.

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 worked in partnership with health and social care professionals. Health and social care professionals spoke positively about the registered manager and staff and their joint working relationships.

Action had been taken since our last inspection in relation to staff training and support. A system to help ensure staff were suitably trained and supported was in place. Due to the impact of COVID-19 and the current cost of living crisis; recruitment was ongoing. Agency staff were used to cover shifts which permanent staff were unable to work. People and relatives spoke positively about the knowledge and skills of permanent staff; they were less positive about the skills of some agency staff.

Staff explained that staffing levels did affect morale at the home, since they did not always have time to provide care which was person centred. They also said they did not always feel appreciated or valued by the registered manager or provider. We spoke with the registered manager and regional manager about this feedback. They explained the staff reward systems in place and told us how much they appreciated staff and their hard work.

People and relatives spoke positively about the caring nature of staff. Comments included, “Aye they are very caring and there is one carer who is so caring with everyone. They know her needs, she looks well and has put weight on. They know everyone and their personalities. There are a lot of nice carers there” and “Everything seems to be good and settled, I think she is in a good place myself, I have watched them treat her well and other residents as well.”

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 18 January 2023). There were breaches of the regulations relating to medicines management, staffing levels, staff training and support and the management of the service. 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 that whilst the provider had made improvements in some areas they remained in breach of regulations.

This in the third consecutive inspection where the provider has been in breach of the regulations relating to medicines management and good governance and has failed to achieve a rating of at least good.

Why we inspected

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 of safe, effective and well-led which contain those requirements.

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 remains requires improvement. This is based on the findings at this inspection.

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.

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 Lodge Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified 3 breaches the Regulations relating to Safe care and treatment [medicines management], Good governance and the requirement to display their CQC performance rating.

Full information about CQC’s regulatory response in relation to the provider’s failure to display their rating is added to reports after any representations and appeals have been concluded.

We have made two recommendations in the effective key question. Please see this section for further details.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.