This inspection was carried out over three days on the, 7, 8 and 17th of November. Our visit on the 7 November 2017 was unannounced. At the last inspection on 30, 31 January 2017 we rated the service as requires improvement overall. We identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, consent, safety checks, recruitment checks, staff training and induction. We also issued a warning notice for lack of good governance and we issued a fixed penalty notice for failing to submit required notifications to the Care Quality Commission.

This inspection was to check satisfactory improvements had been made and to review the ratings. The provider sent us an action plan that detailed how they would make improvements to become compliant with the regulations. At this inspection we found improvements to the service and found the warning notice to have been met.

Priestnall Court is situated in Heaton Mersey, a residential area of Stockport. The home provides support for up to twenty four people, who require help with personal care. At the time of our inspection twenty four people were living at the home. Nineteen bedrooms have en-suite bathrooms and are of single occupancy, although one double room is available for those wishing to share facilities. A passenger lift is available for easy access to the first floor level. On the ground floor the communal areas consist of a dining room, two lounges, one contained a television for people to watch and there was also a quieter lounge for people to sit and talk. Car parking spaces are available to the front of the building and there is a well maintained garden to the rear of the property. A variety of amenities are within easy reach, such as shops, a library, supermarket, pub, restaurant, park and a cinema. Public transport links to Stockport town centre are nearby.

A registered manager was in place. 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.

We saw there was a concerns and complaint policy included in the statement of purpose that was given to each person on admission to the home. The people living at Priestnall Court and the visiting relatives we spoke with told us they had no concerns or complaints.

From our observations of staff interactions and conversations with people living at the service, we saw staff had good relationships with the people they were caring for. The atmosphere felt relaxed and people told us they felt comfortable.

Activities were provided by the staff and visiting entertainers. The service utilised the supply of games and activities to help provide access to regular events throughout the week.

Procedures were in place to minimise the risk of harm to people using the service. People received their medicines safely and as prescribed by their doctor.

Staff were recruited following a safe and robust process to make sure they were suitable to work with vulnerable people.

People were supported by sufficient numbers of staff to support them to participate in their daily activities within their home. We found there was a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant the registered provider could show that the staffing levels and skill mix of staff was sufficient to meet the assessed needs of people living at Priestnall Court.

Staff were receiving regular supervision sessions and appraisal. This meant that staff were being appropriately guided and supported to fulfil their job role effectively. Staff received regular training and support to ensure they had the necessary skills and updates

This inspection was carried out over three days on the 30 and 31 January and 1 February 2017. Our visit on 30 January 2017 was unannounced.

At the last inspection on 23 and 24 November 2015 we rated the service as requires improvement overall. We identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, consent, staff training, and good governance.

This inspection was to check satisfactory improvements had been made and to review the ratings. At this inspection we found multiple breaches of the regulations. These were in relation to safe care and treatment, consent, premises and equipment, good governance, staffing and fit and proper persons employed. We are currently considering our options in relation to enforcement in relation to some of the breaches of regulations identified. Full information about the Care Quality Commission's (CQC) regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Priestnall Court is situated in Heaton Mersey, a residential area of Stockport. The home provides support for up to twenty four people, who require help with personal care. At the time of our inspection twenty four people were living at the home. Nineteen bedrooms have en-suite bathrooms and are of single occupancy, although one double room is available for those wishing to share facilities. A passenger lift is available for easy access to the first floor level. On the ground floor the communal areas consist of an attractive dining room, two lounges, one contained a television for people to watch and there was also a quieter lounge for people to sit and talk. Car parking spaces are available to the front of the building and there is a well maintained garden to the rear of the property. A variety of amenities are within easy reach, such as shops, a library, supermarket, pub, restaurant, park and a cinema. Public transport links to Stockport town centre are nearby.

The home had a manager registered with the Care Quality Commission (CQC), who was present throughout the three days of inspection. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.

Some medicines were not managed safely. For example we found there were not always clear, detailed written directions for the use of prescribed creams to enable staff to apply the creams as intended by their general practitioner (GP). This meant there was a risk prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort to the person and people were not receiving their medication as prescribed.

We saw that one person had not completed the full course of antibiotics that had been prescribed when they were discharged from hospital following an infection. Because of the concerns in relation to this part of medicines management we raised a safeguarding alert with the local authority. These concerns were formally progressed under the local authority safeguarding protocol.

We had concerns in relation to staff supervision. Since our last inspection staff had only received one supervision session and no staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.

Recruitment processes required improvements to ensure only suitable staff were employed to work with vulnerable people.

Some of the routine safety checks in the home had not been undertaken for example the nurse call bells, portable appliance testing (PAT). Other safety checks, for example means of escape, fire alarm testing and emergency lighting had not been undertaken

During our visit to this location we were able to speak with four people living at the home who in general, provided us with positive comments. They told us they felt safe whilst care and treatment was being delivered and their needs were being met by a kind and caring staff team.

We found staff to be well supported and appropriately trained and those living at Priestnall Court looked comfortable in their presence. We also spoke with a visiting external professional, who was very complimentary about the staff team and the managers of the home.

Comments from those living at the home included:

"It is like home from home!"

"They (the staff) are very nice indeed. They look after everybody."

"I have been in a few places, but this is the one I would choose."

"This is a lovely home. Very friendly and homely. We are very comfortable. The staff are great."

During our inspection we assessed standards relating to consent, care and welfare and how people were supported to be involved in the planning of their own care. We also looked at the cleanliness of the environment and the effectiveness of infection control. Standards relating to staff training and monitoring the quality of service provision were also inspected. We did not find any concerns in the areas we assessed on this occasion.

People who used the service who told us:

“They look after us”.

“The food is usually very good”.

“The staff are very good”.

We spoke with relatives who told us, “The home is very good, my relative is well looked after. The staff are very good, they tell us what’s going on. They do a brilliant job”.

This was an unannounced comprehensive inspection which took place on 23 and 24 November 2015. We last inspected Priestnall Court on 2 November 2013. At this inspection we found the service was meeting the regulations we reviewed.

Priestnall Court is situated in Heaton Mersey, a residential area of Stockport. The home provides support for up to 24 people older people, who require help with personal care. The majority of bedrooms have en-suite bathrooms and are of single occupancy, although one double room is available for those wishing to share facilities. A passenger lift is available for easy access to the first floor level. Car parking spaces are available to the front of the building. A variety of amenities are within easy reach, such as shops, a library, supermarket, pub, restaurant, park and a cinema. Public transport links to Stockport town centre are nearby.

There was a manager in post who was registered with the Care Quality Commission. 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 and associated Regulations about how the service is run.

We identified 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.

Although the provider had policies and systems in place for the safe storage of medication, we saw that medicines were not always stored away safely. This meant that there was a risk of medicines going missing and not being dispensed properly.

Staff were not always provided with supervision or appraisal. The service had a training and development policy which stated that staff should receive supervision six times per year and a formal appraisal annually. Staff we spoke to told us that although they felt supported by the manager they had not recently had a formal supervision session and the records we looked at did not provide evidence that the policy was followed. This meant that there were no quality systems in place for monitoring the performance of individual staff members or for allowing collective understanding of issues or concerns.

People told us they felt safe and well cared for. One person told us “The staff are busy but they always have time for us. They are all so nice to all of us.” One visitor we spoke to told us that they had chosen the home for their relative because of the friendly homely atmosphere and the caring nature of the staff. Staff supported people with kindness, respecting their dignity and offering meaningful choices about aspects of their daily lives and we saw that members of staff sought the consent of the people who used the service. However, the Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS)

We checked whether the service was working within the principles of the MCA where individuals were unable to consent or object to care and treatment. We found that the proper authorisation to seek a DoLS had not been requested.

Systems were in place to reduce the risk of harm and potential abuse. The provider’s safeguarding adults and whistle blowing procedures provided guidance to staff on their responsibilities to protect vulnerable adults from abuse. Staff were able to demonstrate a good understanding of how they would use the policies if they had any concerns about the safety and well-being of people who used the service.

Recruitment and selection procedures were in place to help ensure that the staff employed at the home were suitable to work with vulnerable adults and there were sufficient numbers of staff available to support people. The registered manager recognised the need to employ extra staff to cover busy times in the day, particularly around breakfast time and in the evening as people were starting to get ready to retire to their rooms.

There were no restrictions in place on people’s movement within the home, there were two lounges; a larger lounge contained a television for people to watch and there was also a quieter lounge for individuals to sit and talk.

We were told that there were some activities arranged, although there were none on the days we carried out our inspection. We saw that people were often left to find their own stimulation, but the staff were vigilant and would frequently engage the people who used the service in pleasant conversation.

Priestnall Court had a comfortable calm and relaxed atmosphere. The manager and proprietor had noticed that the furniture and décor was looking worn and had agreed to purchase new furniture and begin a process of redecoration.

The Registered Manager told us that they try to build good relationships between the staff and the people who use the service to create an open friendly atmosphere. The staff had developed good relationships with all the people who used the service. We observed good social interactions and people were treated with kindness and respect by staff who knew them well, and one carer, speaking about the people who used the service, told us “they are family and this is their home. Home is where you feel safe and cared for. This is what we do”.

The management of the home focussed on supporting people on a day to day basis; whilst this provided person centred care the quality of the records and case files for the people who used the service did not reflect the day to day care we witnessed. So, for example, risks might be identified but the care plans did not identify ways to reduce these risks.

The home had received relatively few complaints, but there were complaint/concern forms available in the entrance area. Anyone who wished to make a complaint was encouraged to do so.

The registered manager was knowledgeable about the people who lived in the home and had the respect of all the people we spoke to. A member of staff said to us “The manager supports us and helps us to do our job. We all get on and that gives it a lovely homely feel.” However, the service did not have sufficient systems in place to ensure that regular quality checks or record management systems were in place to drive forward improvements.