We carried out an inspection of Primrose Villa on 27 and 28 February 2018. The first day of the inspection was unannounced.

Primrose Villa 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. The home has 15 beds and is situated in the Standish area of Wigan. At the time of our inspection there were 13 people living at the home.

The home was last inspected on 23 and 24 November 2016, when we rated the service as ‘requires improvement’ overall and in the key lines of enquiry (KLOE’s); safe, effective, responsive and well-led. The home was rated good in the KLOE caring. We also identified four breaches in three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing, person centred care and good governance. We also made two recommendations in relation to the recording of fluids and ensuring the environment was dementia friendly.

At this inspection we identified one continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance. You can see what action we asked the provider to take at the end of the full version of this report.

At the time of the inspection 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 2008 and associated Regulations about how the service is run.

All the people we spoke with told us they felt safe, and enjoyed living at Primrose Villa. Relatives were also complimentary about the standard of care provided. Staff had received training in safeguarding and knew how to report concerns. The home had appropriate safeguarding policies and reporting procedures in place, although there had not been the requirement to make a safeguarding referral since the last inspection.

We found the home to be clean with appropriate infection control processes in place. Staff wore personal protective equipment (PPE) to prevent the spread of infection and the home employed a housekeeper, who ensured all communal areas, bathrooms and bedrooms were clean and tidy.

Both people using the service and staff we spoke with told us enough staff were deployed to meet needs. The home used a system to determine safe staffing levels, which we saw tallied with the rotas.

We saw medicines were stored, handled and administered safely and effectively. All necessary documentation was in place and was completed consistently. Staff responsible for administering medicines were trained and had their competency assessed annually.

Staff spoke positively about the training available. We saw staff had completed an induction programme upon commencing employment and on-going training was provided to ensure skills and knowledge were up to date. Staff also confirmed they received regular supervision and annual appraisals, which along with the completion of monthly team meetings, meant they were supported in their roles.

Meal times were observed to be a positive experience, with people being supported to eat where they chose. Staff engaged in conversation with people and encouraged them throughout the meal. We saw drinks were available in all communal areas throughout the home and people were supported and encouraged to drink on a regular basis.

Throughout the inspection we observed positive and appropriate interactions between the staff and people who used the service. Staff were seen to be caring and treated people with kindness, dignity and respect. Our observations showed staff clearly knew the people they supported and had formed positive work

We carried out an unannounced inspection of Primrose Villa on 23 and 24 November 2016.

Primrose Villa is a 15 bed residential care home situated in the Standish area of Wigan. Accommodation is provided over two floors with wheel chair access to all floors via a fully automatic lift. The home has parking facilities for eight cars and a large garden area to the rear of the property. At the time of our inspection there were 13 people living at the home.

The home was last inspected on 10 and 15 February 2016, when we rated the service as ‘inadequate’ overall. We also identified six breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to maintaining a safe environment, staff recruitment, management of medicines, records, staffing levels and governance.

At this inspection we found the service had made improvements in regards to the management of medicines, safe recruitment practices and record keeping, however identified four breaches in three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to staffing levels, person centred care and good governance. You can see what actions we told the provider to take at the back of this report. We also made two recommendations in relation to the recording of fluids and ensuring the environment was dementia friendly.

At the time of the inspection 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 2008 and associated Regulations about how the service is run.’

We saw that overall the home was clean and had appropriate infection control processes in place. The service employed a housekeeper who was responsible for the cleanliness of both the communal areas and people’s rooms. Cleaning equipment was stored safely and securely.

People we spoke with told us they felt safe. The home had appropriate safeguarding policies and procedures in place, with instructions on how to report any safeguarding concerns to the local authority. Staff were all trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report any safeguarding or whistleblowing concerns.

Most of the staff we spoke with told us enough were employed to meet people’s needs; however one said an additional carer would be beneficial. People using the service also had mixed views with some believing there to be enough, whilst others commented on long waiting times and the need for an extra staff member. From our observations during inspection and reviewing various records, we noted that people were often left unsupervised in the lounge and dining area, whilst staff attended to people’s needs in other parts of the home.

People using the service also provided differing opinions on the activity programme provided by the home. Some stated they were satisfied with what was on offer whilst others did not believe enough activities were planned, and what was scheduled wasn’t of interest to them. Two people stated they enjoyed going out of the home, such as for walks to the local shop, however this happened very infrequently as there was not enough staff to facilitate this.

We looked at three care files in detail and each contained detailed information about the people who used the service and how they wished to be cared for. Each file contained comprehensive care plans and risk assessments, which helped ensure people’s needs were being met and their safety maintained. People and their relatives had been asked if and how often they wanted to be involved in reviewing their care. We looked at an additional four files to capture people’s opinions and saw that the majority only wanted to be informed of any chang

This inspection took place on 10 and 15 February 2016 and was unannounced. We last inspected Primrose Villa Care Home on 26 September 2014 when we found the service to be meeting all standards inspected.

Primrose Villa Care Home is a 15 bed residential care home situated in the Standish area of Wigan. The service has car parking facilities and bedrooms are located on two floors. There was a bathroom, wet-room with a shower and shared toilet facilities. One bedroom at the home was en-suite. At the time of our visit there were 14 people living at the home.

At this inspection we identified breaches of six of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to maintaining a safe environment, staff recruitment, management of medicines, records, staffing levels and governance. You can see what actions we told the provider to take at the back of this report. We are also considering our options in relation to enforcement regarding some of these breaches and will update the section at the end of this report once any action has concluded.

There was a registered manager in post at the time of our visit. 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 found issues in relation to the safety of the environment at the home. We found one of the first floor bathroom windows was in a poor state of repair. The window frame was rotten and there was a gap between the window pane and the frame in one corner, which meant the window was not secure or safe. We also found many of the window restrictors on the first floor were not operating correctly, which meant the windows could be opened without restriction. These issues meant people were being placed at risk.

Medicines were not being managed safely. We identified there had been a medicines error the week prior to our inspection where people had not received their night-time medicines. The registered manager was not aware of this until we alerted them. Staff told us they thought the issue had been in relation to staff on that shift not having received medicines training.

We had not received any notifications of safeguarding incidents at the service in the year prior to our inspection. Staff we spoke with were aware of how to identify possible signs of abuse or neglect and of the appropriate actions to take to report any concerns. People told us they felt safe living at the home.

Care plans had been regularly reviewed, although some lacked detail. We also found care was not always being provided in line with the care plans. For example, we found one person’s dietary requirements were not clearly or accurately recorded in the care plan, and there were inconsistencies when we asked staff what support was being provided. Another person’s care plan did not accurately reflect the support they were currently receiving in relation to mobility. This increased the risk of the care being provided not being appropriate to people’s needs or not meeting their preferences.

We found staffing levels were lower at weekends than during the week, with two care staff supporting all the people at the home at times. This included people who required two staff to assist them in relation to various care tasks, including mobility. This would mean other people at the home would be left without available staff support at times. There was no clear process for assessing staffing level requirements based on people’s needs.

People told us they liked the food provided and said they were able to request alternatives if they didn’t like what was on the menu. Presentation of pureed meals could be improved as all items in the meal had been blended together. We also

This is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

We asked the following five questions.

Is the service safe?

The people who lived at the home and their relatives were pleased with the care provided and felt their views were respected and listened to. One person said: “It’s small, homely and very secure.”

The staff worked in a safe and hygienic way and used appropriate protective clothing when providing personal care and handling food. There were enough staff to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

Staff personnel records contained all of the information required by the Health and Social Care Act. This meant the provider could demonstrate staff employed to work at the home were suitable and had the skills and experience needed to support the people living at the home.

The registered manager and the staff we spoke with understood the importance of safeguarding vulnerable adults,and could identify potential abuse and knew how to report any incidents of abuse. Members of staff understood the whistleblowing policy and were confident to use it. One staff member said: “If I saw anything I did not like I wouldn’t put up with it .”

Is the service effective?

People told us they were happy with the care they received. One relative said “I think that the home is fulfilling her needs.”

Care records confirmed people’s preferences, interests, needs had been recorded and care and support had been provided in accordance with people’s wishes. One person said: “I don’t think anyone has any complaints about it.”

We heard from staff information was shared very effectively. Several ways of sharing information included handovers, daily records, and monthly reviews with relatives.

Is the service caring?

We saw people were supported by kind, friendly and attentive staff. Care workers showed patience and encouragement when supporting people. One member of staff said: “I concentrate on the residents. I don’t talk to other staff whilst I’m supporting them.“ One person using the service said: “The staff are very friendly, welcoming and caring.”

Is the service responsive?

People’s needs had been assessed before they were admitted to the home and were carefully described so care workers knew exactly what tasks to undertake to support them. Changes in people's care needs were reported to the senior carer and they briefed care staff at handovers.

One person who lived at the home told us about the range of activities they could access and said: “We usually find something to do. I like walking to the shops and the school.”

Is the service well-led?

Staff had a good understanding of the culture of the home and quality assurance processes were in place. One relative said: “I know exactly what is going on. There’s good passing on of information.” People told us staff listened to their concerns. The registered manager met informally with families, was available whenever they visited and hosted meetings to discuss concerns and consult on any proposed changes. Staff told us they were clear about their roles and responsibilities and said: “If I have any problems I can just bring them up. They give me support. They help us.”

When we visited in May 2013 we found the service to be non compliant in two areas. The purpose of this visit was for us to see what improvements had been made by the provider.

During this visit we saw that improvements had been made in the identified areas.

We saw that people were being supported by staff at mealtimes in an appropriate way and observed the staff to be interacting well with each other and the people living at the home who they treated with dignity and respect.

On the day of the inspection we found that all of the people living at the home were groomed and well presented.

One person living at the service that we spoke with told us how they enjoyed playing on the Wii Game and another that they enjoyed living there. A relative told us ''The staff are excellent'' and that they had guided them through the process of their relative moving in.

We saw that staff interacted well with the people living at the service and treated them with respect.

The service employed an activities coordinator and we saw reports in the newsletter of events that had taken place since our last visit.

However, it was recorded in a visitors concerns document by staff that a relative was concerned about the maintenance of the decor and this included the cleanliness of the lounge carpet. A staff member and the manager told us that they had addressed the issue as best as they were able to and that the concern would be passed on to the directors.

On the day of the inspection we found that all of the people living at the home were well groomed and presented.

The people living at the service that we spoke with told us that they were well looked after. One person who lived there told us that they had their breakfast at 8 o 'clock but could have it at any time that they wanted. A relative told us that '' All of the staff are kind and they make chips especially for my mum.''

We saw that staff interacted well with the people living at the service and treated them with respect.

The service employed an activities coordinator and there were a variety of events advertised.

Following the inspection, arrangements were made for a fire officer to visit the premises due to our concerns with the fire exit doors.

"I have lived here for a long time: Everyone looks after me nicely".

"I have alwyas been happy with the care here. My Mother is looked after very well."

"We are looked after well."

"I feel happy knowing that my Mother is safe here."

"We have seen a real change in X : She is not the same woman , its great to see her looking so well."