About the service:

Primley House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Primley House accommodates up to 39 people in one adapted building. At the time of our inspection there were 34 people living in Primley House. The home supports people with different needs and backgrounds, including people with mobility needs, health needs and mental health needs.

People’s experience of using this service:

•People spoke very highly of the care they received at Primley House. The service had strong person-centred values and placed people’s wellbeing at the heart of their work. People received exceptionally personalised support which met their needs and preferences.

•The registered manager was passionate about continuous improvement and implemented ideas and new ways of working in order to better people’s care and wellbeing. For example, the service had developed a relationship with the local primary school and the local nursery. This brought people a great deal of pleasure. The home also held regular fund-raising events, parties and fetes where people, relatives, staff and members of the public were welcome.

•People were fully involved in the planning and delivery of their care and encouraged to share views and make suggestions about the way the home was run. People were given as many choices as possible and were encouraged to have control and be independent.

•People were given access to a wide range of activities which met their personal preferences. Staff knew people well and were described as being kind and caring. Staff were provided with the training, supervision and support they needed to care for people well.

•The home delivered outstanding end of life care to people. The service was passionate about ensuring people received dignified and respectful end of life care which met their personal needs and preferences. The service had also created a memory garden to show respect for people who had passed away. Each time a person sadly passed, staff planted a rose in this garden to remember them by. This brought comfort to relatives, people who lived in the home and staff.

•Risks to people’s health, safety and wellbeing were assessed and acted upon. During our inspection we identified some medicine stocks did not tally with the stocks recorded on people’s medicine administration records. However, following our inspection the registered manager conducted an audit of medicines and was able to assure themselves and us that people had been receiving their medicines as prescribed.

•People were protected from potential abuse by staff who had received training and were confident in raising concerns. There was a thorough recruitment process in place that checked potential staff were safe to work with people who may be vulnerable.

•The service had recently changed their care planning system from a paper to a digital format. We found people’s care plans contained clear information about their needs, but further improvements were needed with regards to the amount of personal information and preferences available. People were clear that staff knew them and how to care for them in the way they wanted.

•There was strong leadership at the service. People and staff spoke highly of the management team and there was a positive culture at the service with people and staff feeling their voices were listened to.

•There were effective quality assurance systems in place to assess, monitor and improve the quality and safety of the service provided. More information is in the full report.

Rating at last inspection: At the last inspection the service was rated Good (20 October 2016). It was rated Good in the Safe, Caring, Responsive and Well-led key questions and Requires Improvement in the Effective key question.

Why we inspected: This insp

This unannounced inspection took place on 5 and 6 September 2016. The home was previously inspected in February 2014 and was meeting the regulations we looked at.

Primley House was a residential home in Paignton, Devon providing accommodation and care for up to thirty nine people. On the day of our inspection, thirty four people were living at the home. Primley House was a friendly and caring home for older people in the former Georgian Home of the late Herbert Whitley, the founder of Paignton Zoological Gardens. The attractive accommodation consists of two lounges, a large sun lounge overlooking an attractive garden and a spacious dining room overlooking the terrace. In addition there was a library for people to enjoy. People’s rooms varied in size and had en-suite facilities.

The home 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 and associated Regulations about how the service is run.

People told us they were happy and felt well cared for. It was clear to see people were comfortable living at Primley House and really felt at home. People’s care was personalised and detailed, and it was evident that staff knew people they were supporting very well. We saw them interacting with kindness and compassion. People and their families described management and staff as caring, respectful and approachable. The families we spoke with had regular contact with the registered manager.

People told us they felt safe, and we found the registered manager had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in safeguarding of vulnerable adults. Staff were knowledgeable about how to recognise and report abuse. We saw risk assessments in place regarding risks associated with people's care. These explained how people's care should be delivered in a safe way and how to reduce any risks involved.

We checked to see if the registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). From discussion with the registered manager it was noted that people using the service had capacity to make decisions and therefore applications to deprive people of their liberty, at this time, were not required. People's care records showed some assessments of people's capacity levels had been carried out but this was an overall assessment of capacity and not decision specific. Where people had the capacity to consent to their care and treatment, the consent was not recorded. Documentation of best interests decisions did not record who had been involved in the decision making process. We made a recommendation that the provider seeks recognised national guidance on the Mental Capacity Act in order to ensure staff support people appropriately and follow this legislation.

Staff had been recruited appropriately to ensure they were suitable to work with vulnerable adults. Recruitment systems and processes that were in place were robust. We saw references and identity checks were carried out, as well as Disclosure and Barring Service checks. People who lived at the home, families and staff told us there were sufficient numbers of staff on duty at all times.

Staff knew how to meet people’s needs. Records showed they had a thorough induction and on going training to help ensure they had the skills and knowledge they needed to provide effective care. We checked to see if staff were receiving regular supervisions, appraisals and checks of their competency to ensure they continued to be effective in their role. Staff records we sampled did not demonstrate that supervisions had been held regularly. However, we were told by staff that they were s

We looked at four care plans, and spoke to four people who used the service. We spoke to a visiting GP, and the physiotherapist that works at the home. Everyone we spoke to said nice things about the way the service was run and the care they provided to people living there.

One person using the service told us "you won't find a better home."

We saw care workers interacting appropriately with people using the service by speaking to them at their level, and addressing them in their preferred way.

We found that Primley House had systems in place to ensure the care needs of the people living there were appropriately assessed, managed, and reviewed. This meant that people received appropriate safe and effective care.

On the day of our inspection 32 people were living at the home and receiving care from the service. We (the Care Quality Commission) spoke with four people living at the home, three staff, one relative, a district nurse and the manager. We also spent time observing care and we looked at three care plans.

People living at the home we spoke with told us they were looked after very well. One said “I am very happy here”. A relative told us “It’s just brilliant”.

We saw clear evidence of the involvement of external healthcare and community support services. We saw that people had opportunities to participate in activities of their choosing. We saw that people were consulted about what they wanted to do, and about how they wanted their care to be delivered.

People said they felt safe living at the home and thought there were enough staff on duty.

All records were well maintained at the home and showed that there were effective

All of the people that we spoke with were happy with their care at Primley House. One person described the home as “the best".

Some people told us they were able to manage the majority of their healthcare needs independently, whilst others said they asked staff for support. People said that they felt their care was coordinated well and explained that should they need any further support or care, this was arranged by staff, which then followed the guidance and advice given by the healthcare professionals.

People we spoke with said they felt they could voice their opinions on how the care home was run.

People said they enjoyed the activity in and out of the home. Others said they made their own entertainment or preferred to stay in their room and liked that they could chose what to do.

All of the people we spoke with said the food was good.

People said they felt safe at the home.

People told us they receive their medication on time.

People told us they thought there were enough staff and described them as "really kind" and "very good". There were no negative comments about staff or management. Friendly chats and laughter was shared throughout the day between staff and people living in the home.