This inspection took place on 27 March 2018 and was unannounced. This meant the staff and the provider did not know we would be visiting.

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

Primrose Court Care Home accommodates 20 people with residential care needs across two floors. On the day of our inspection there were 14 people using the service.

The home had a registered manager in place. 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 2008 and associated Regulations about how the service is run.

Primrose Court Care Home was last inspected by CQC on 8 February 2017 and was rated Requires Improvement overall and in two areas; safe and well-led. We informed the provider they were in breach of Regulation 12: safe care and treatment and Regulation 18: staffing. The risks to people from unexpected incidents such as fire were not managed in a safe manner and there were insufficient staff on duty overnight to meet the needs of the people who used the service.

Whilst completing this inspection we reviewed the actions the provider had taken to address the above breaches. We found the provider had ensured improvements were made to meet the above regulations. However at this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is therefore the second consecutive time the service has been rated Requires Improvement.

The provider did not have effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were not always carried out.

The provider had audits in place to measure the quality of the service however some of the audits had failed to successfully identify the deficits we found in the service.

The home was clean, spacious and suitable for the people who used the service.

Accidents and incidents were appropriately recorded and risk assessments were in place. The registered manager understood their responsibilities about safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe management and administration of medicines.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people who used the service.

Staff were supported to provide care to people who used the service through a range of mandatory and specialised training, supervision and appraisal. Staff said they felt supported by the registered manager.

People who used the service and their relatives were complimentary about the standard of care at Primrose Court Care Home.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Care records showed people’s needs were assessed before they started using the service and care plans were written in a person centred way and were reviewed regularly. Person centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs.

People had access to healthcare services and received ongoing healthcare support.

Activities were arranged for peo

We inspected Primrose Court Care Home on 8 February 2017. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting.

We inspected the home in October 2015 and found there were gaps in staff training and supervision; the care records needed to be accurate and up to date; medication administration arrangements needed to be enhanced; and the performance management and audit systems needed to be improved. We found that the home was breaching regulation 9 (Person-centred care), regulation12 (Safe care and treatment), regulation 17 (Good Governance) and regulation 18 (Staffing). We rated Primrose Court Care Home as ‘Requires improvement’ overall and in four domains.

Primrose Court is registered to provide residential care and support for up to 20 older people some of whom maybe living with dementia. Each person has their own private bedroom and access to shared communal areas. At the time of the inspection 16 people used the service.

The home has had a registered manager in place since the home registered in August 2015. 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.

Following our last inspection the registered provider sent us information, in the form of an action plan, which detailed the action they would take to make improvements at the home.

At this inspection we found the action the registered manager had been taken had made significant improvements to the way the home was run. The team had worked collaboratively to ensure all of the previous breaches of regulation were addressed.

During the inspection we found that there were insufficient staff on duty, particularly overnight. All of the 16 people who used the service needed the support of at least one member of staff and a quarter of the people needed two staff to assist them. During the night two staff were on duty and we were informed that this had been the case for many years. The registered manager told us that no dependency tool was used to calculate the staffing levels and no consideration had been given to the peoples’ gradual increased dependency.

We saw that fire precautions, procedures and the fire risk assessment needed to be improved. The fire procedures referred to one staff member guiding people to the fire point and taking charge of making sure all were accounted for whilst the other staff assisted people to leave the building. Overnight with only two staff on duty it would be impossible to adhere to this procedure. We also noted in the last eighteen months no night staff had completed fire drills. When we discussed what action they would need to take in the event of a fire the night staff did not realise they were to support people to evacuate the home.

During the day a senior and two care staff were on duty. We noted that the home had accessed apprenticeship schemes and two apprentices were on duty. The staff we spoke with included the apprentices in the numbers of staff on duty and treated them as full member of the team. From our discussions with the registered manager we found that the apprentices were to be supervised when completing any personal care tasks. However we could find no system in place to identify which staff member was allocated to supervise each apprentice. Also there was no mechanism in place to support and verify the learning the apprentices completed each shift.

We found that overall the administration and management of medication was in line with people's prescriptions. However staff needed to enhance the procedures for checking and booking in quantities of bottled medication and medication that were received outside of the monthly delivery.

People told us they were happy with t

We inspected Primrose Court on 15 October 2015. The inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting.

Primrose Court provides care and support for up to 20 older people and / or older people with a dementia. The service is close to all local amenities.

The home had a registered manager 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.

Risks assessments for people who used the service were insufficiently detailed. This meant that staff did not have the written guidance they needed to help people to remain safe.

Care plans were insufficiently detailed to ensure that care needs were met. The registered manager and deputy manager had already commenced a review of care files prior to the visit and were to rewrite the care plans of all people who used the service

We looked at the arrangements in place for quality assurance and governance. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations. We were shown numerous checks which were carried out, however we would question the effectiveness of some of these audits as they did not pick up on the areas we identified as needing improvement.

We looked at a chart which detailed training that staff had undertaken during the course of the year. We saw that 79 % of staff had completed training in infection control and 75 % had completed fire training. We saw that 68 % of staff had completed training in moving and handling and 64 % of staff had completed training in safeguarding. The majority of gaps with this training were for the cook, kitchen assistants and housekeeping staff. The registered manager told us that health and safety training was completed on a three yearly basis. Records looked at during the visit indicated that only 50% of staff had completed this training. We saw none of the staff were up to date with first aid training.

Systems were not in place for the management of medicines to make sure that people received their medicines safely. Whilst checking Medication Administration Records (MARs) we noted that routine medicines for different people were delivered to the home at different times during the month. This increased the risk of people running out of their medication supply. Records for people who were prescribed anticoagulant therapy were not up to date. This medicine is used to treat and prevent blood clots and because it can reduce the ability of the blood to clot the person requires careful monitoring in the way of testing of the blood. From the records we looked at we could not see that blood tests had been carried out as often as they should be. The anticoagulant Alert Card which identifies medication prescribed had not been kept up to date. This alert card is important in an emergency and is used to inform professionals before other treatment is received.

The registered manager undertakes a monthly check on medicines; however this audit is insufficiently detailed to pick up on areas of concerns identified by both the local authority and the areas that we identified.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

We saw that staff had received supervision four times a year. The registered manager told us they are to increase this to ensure staff receive supervision at least six times a year. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We looked at the records of staff on duty and found that they had received their annual appraisal.

The local authority identified at their visit in August and September 2015 that the registered manager and staff had a poor understanding on the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances. Since the last visit from the local authority we could see that the registered manager and deputy manager had been working really hard. The care records we reviewed contained appropriate assessments of the person’s capacity to make decisions. The registered manager and deputy manager acknowledged that there was still work to be done to ensure that appropriate assessments and documentation was on file for all people who might lack capacity.

At the time of the inspection, some people who used the service were subject to a Deprivation of Liberty Safeguarding (DoLS) order. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. The registered manager told us that following the local authority visit and completion of assessments there were other people who used the service would need a DoLS referrals and that they were to do that as a matter of priority.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. Observation of the staff showed that they knew the people very well and could anticipate their needs. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of food and drinks which helped to ensure that their nutritional needs were met. People had been weighed on a regular basis and nutritional screening had been undertaken.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People spoke positively about the activity co-ordinator and told us the regularly went out to the local library where events were held and to the local shops. They told us that they like the in-house activities which consisted of on bingo, dominoes, a picture quiz and soft ball game’s

The registered provider had a system in place for responding to people’s concerns and complaints.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.