This inspection took place on 04 October 2018 and was unannounced. At our previous inspection in 2016 we rated the service as overall ‘Good’, with a ‘Requires Improvement’ rating for the ‘Effective’ domain. This was to do with how peoples consent was recorded. At this inspection we found the registered manager had addressed those issues, however we identified areas within the ‘Safe’ domain that would benefit from improvement.

Priory Court Care Home ‘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. The service can accommodate up to 89 older people. Care is provided across three floors in six units (named after flowers and trees). At the time of our inspection there were 83 people using the service. A large proportion of people where living with varying degrees of dementia.

There was a registered manager in post. 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. The registered manager was present on the day of the inspection.

The registered manager and the staff team were trying hard to give a good standard of care for each person. People said they felt safe and well cared for by kind and caring staff and were happy, with good food and the homely setting. Relatives told us they felt secure in the knowledge their relatives were safe and that the staff are kind and supportive. Relatives felt listened to.

Staff practice around infection control, and completion of care records, such as food and fluid charts, and updating risk assessments, had been identified as needing improvement by the providers quality assurance processes. The actions to rectify these issues were ongoing at the time of our inspection , as we also saw examples were staff practice could improve in these areas. We also had mixed feedback about the numbers of staff deployed around the home. This feedback was received from people, their relatives, and some of the staff. Most was very positive about the staffing levels, saying they were always friendly, responded quickly to call bells, and took time to sit and talk with people. However some feedback said that at busy times of the day, people had to wait for care and support. We have made three recommendations around the issues of infection control, completion of records and staff deployment to the provider.

People were protected from the risk of abuse because staff understood their roles and responsibilities should it be suspected. Robust recruitment practices were carried out to ensure new staff were suitable and safe to work at Priory Court Care Home. Peoples medicines were managed and they received them as prescribed.

Peoples needs are assessed before they move into the home, to ensure staff and the facilities can meet those needs. The registered manager said that people from different cultures and from the lesbian, gay, bisexual and transgender communities would all be welcome at the home and made to feel safe. Ongoing adaptations were being made to the home environment to make sure it suited the needs of the people who live here.

Staff received training and supervision to give them the skills to provide an effective level of care to people. Staff worked well as a team to ensure information was shared which resulted in people receiving effective care and support.

People were supported to have enough to eat and drink, and feedback about the quality of the food was positive.

Peoples rights under the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were met. People were supported to have maximum choice and cont

Priory Court Care Home is owned by St Cloud Care plc. It provides accommodation for 89 older people. The service has specialist reminiscence and neurological disability unit and hydrotherapy facilities. At the time of our inspection 83 people lived here.

The home had been adapted to meet people’s mobility needs, such as specialist baths for people who could not mobilise well. Adaptions had also been made to meet the needs of people living with dementia. Doorways were clearly marked and signed, and flooring was free from complex patterns, or shiny surfaces that may confuse people. Although adaptations had been made around the home, it still felt homely.

There was a registered manager in post. 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.

The inspection took place on 02 March 2016 and was unannounced. At our last inspection in November 2014 we raised a concern about the level of staffing, and had made recommendations around the environment and activities for people. These issues had all been addressed by the provider at the time of this inspection.

There was generally positive feedback about the home and caring nature of staff from people and relatives. One person said, ““Staff are very kind and loving.” However another said, “Staff are not terribly efficient” and felt that the home in general was only “alright.” A relative said, “The staff are fabulous – all of them.”

The staff were kind and caring and treated people with dignity and respect. One person said, “I have been able to make friends with the staff here.” Good interactions were seen throughout the day of our inspection, such as staff holding people’s hands and sitting and talking with them. People looked relaxed and happy with the staff. People could have visitors from family and friends whenever they wanted.

People were safe at Priory Court Care home. People were overall positive about the levels of staff at the home. Although some felt they had to wait for staff at busy times, they said staff always came when needed. One person said, “I always get attention when I ask and never have to wait long.”

Risks of harm to people had been identified and clear plans and guidelines were in place to minimise these risks. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

In the event of an emergency people would be protected because there were clear procedures in place to evacuate the building, in a format people could understand. Each person had a plan which detailed the support they needed to get safely out of the building in an emergency.

The provider had carried out appropriate recruitment checks to ensure staff were suitable to support people in the home. Staff received a comprehensive induction and ongoing training, tailored to the needs of the people they supported.

People received their medicines when they needed them. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

Where people did not have the capacity to understand or consent to a decision the provider had not always followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had not always been completed. Staff’s understanding of the MCA was also limited. The provider had already identified this issue across their homes and an action plan was in place to correct it. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the D

On the day of our visit 81 people were using the service. They were supported by sixteen registered nurses and 64 care staff. We were met by the acting manager who explained that the registered manager was off on long-term sick leave. We spoke with eight people who use the service, three relatives, two nursing staff, five care staff, the acting manager and the clinical lead. The home was divided up into four units: a residential unit, a residential unit with nursing, a dementia unit, and a dementia and neurological unit with nursing. The focus of the inspection was to answer five key questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found:

Is the service safe?

The service was safe. Staff had been trained in the management of medication so where appropriate people were being given medicines in a safe and proper manner.

People’s care plans included full needs and risk assessments to ensure they were treated in a way that did not put them at risk of receiving inappropriate care.

There were sufficient staffing levels to meet the needs of the people who lived in the home.

Is the service effective?

The service was effective. Staff were properly trained and competent to carry out their duties. Each person had a fully completed and up to date care plan which was tailored to their specific needs. These plans were monitored and reviewed on a regular basis.

People’s views were taken into account, for example through the use of regular satisfaction surveys, and staff also had the opportunity to give their feedback.

Care staff had either completed, or were in the process of completing, appropriate qualifications in health and social care.

Is the service caring?

The service was caring. People we spoke with about the service said things like, “It’s very good”, “It’s reasonable”, “We have the freedom to go out” and, “You can do more or less what you want”.

Care staff had a good awareness of people’s needs. They were able to consistently monitor people’s health and wellbeing and where necessary make amendments to a person’s care plan.

Is the service responsive?

The service was responsive. There were sufficient staff numbers to ensure that staff were able to attend to people’s needs in a timely manner, and to engage with people in a sensitive and empathic way. There was a full programme of activities which catered for different levels of need.

Care plans were regularly updated to reflect changes in people’s needs.

Is the service well led?

We found that the service was well led. The service had an acting manager and was in the process of recruiting a new registered manager. The provider regularly talked with all staff to seek their views, and to share any issues with them that might affect the service.

There were systems in place to monitor and assess the quality of the service on a regular basis, for example, a service user satisfaction survey. The provider also had systems in place such as compliance visits from the regional office and audits to monitor and evaluate the quality of the service on a continuous basis.

We visited Priory Court Care Home to look at the care and welfare of people who used the service. We spoke with two people who used the service in depth, seven people informally in group settings and four family members.

All the people that we spoke with told us they received good care at the home. Family members confirmed that the care was very good. One family member told us “I am very happy with the care my relative receives.”

We saw that staff consulted with people who used the service and their relatives. This was to ensure they gained consent prior to personal care or treatments being carried out.

Care plans and risk assessments were held on computers. These had been updated regularly and reflected the care needs identified.

Safeguarding training had taken place for staff and they had good knowledge of the procedures to be followed.

Staff had received regular training to ensure they could meet the needs of the people who used the service.

The provider had systems in place which ensured complaints were listened to and taken seriously.

We spoke with eight people who use the service during our inspection. All people told us that they knew about their care as staff always spoke with them. We were told that staff were kind and thoughtful and always cheerful. One person told us “The staff help me with my care and always offer me choices.” Another person told us “I am happy and feel safe here.”

All people thought the staff were always busy but despite this they had time for them. People told us their friends and family could visit them at any time.

During our visit we met with several people using the service and some visitors. The views of people both using the service and visiting varied with some people saying that they thought the care was excellent whilst other people said they felt that aspects of the care provision could be improved.

Several people said that they were not pleased with the evening meals and found that the choices available were very limited and the soup tasted ‘watered down’.

People told us staff were kind, did their best and looked after them well and respected their privacy and dignity. People said the food was good they felt safe and they knew who to talk to if they were unhappy or had concerns. People told us the home was clean and tidy.

People using the service said that they thought the activities were well organised and enjoyed participating in them. Several people said that they would like to be supported to use the gardens and also to have a trip to the local village shop.

People said that they felt at times that staff did not answer the calls bells and they had to wait to have support.

Priory Court Care Home provides personal care and nursing care for up to 89 older people who may also be living with dementia or neurological conditions. 84 people were living in the home at the time of this inspection. People were accommodated in four units dependent on their needs. There was a range of shared lounges, quiet areas and ining rooms on each unit, there were passenger lifts between floors. All areas of the accommodation were accessible to people who used wheelchairs.

This inspection took place on 20 and 24 November 2014. The inspection was carried out in response to concerns received from one relative, a member of staff and a social worker. These related to people’s care, the number of staff available and the management of medicines.

The home did not have a registered manager present during the inspection as a new manager was due to start in early January 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. During the absence of a registered manager two deputy managers had taken charge of different areas of the home and worked closely together supported by the regional manager.

People offered differing views as to whether there were enough staff. Some people told us there were times when they had to wait for staff to help them. Others said there were enough staff to meet their needs and they did not wait long for help. There was system in use to assess if people were having their needs met by enough staff at all times. The provider was in the process of recruiting more staff in repsonse to feedback from staff, people and the deputy manager’s.

People told us that when staff numbers had been lower than usual their expectations regarding being supported with activities had not been met. Although there were some activities on offer people living with dementia did not always participate in meaningful activity during the day. We have made a recommendation related to this aspect of the service.

The system for managing medicines was safe and effective.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff understood how to apply the Mental Capacity Act 2005 (MCA) and appropriate action was taken when decisions needed to be taken in people’s best interests. Staff gained consent from people or their legal representatives before providing care or treatment.

People told us they felt safe. The provider had taken steps to make sure that people were protected from abuse. Staff had been trained to safeguard people and they had the information they needed to respond to and report abuse. Staff told us they would tell the manager or the area manager if they were concerned that any kind of abuse was happening and they were aware of how to contact appropriate external agencies.

Each person’s care plan contained risk assessments, these had been personalised to make sure staff knew how to protect the person from harm. There were plans in place to make sure that people were safe in the event of an emergency.

The deputy managers had followed safe recruitment procedures. References, work histories and photographic identification had been obtained which ensured new staff were suitable to work with people at this home. Staff training records were up to date which showed that staff had the essential training they required to carry out their roles. Staff were supervised and given opportunities to discuss any concerns they might have.

People had commented that the food was not always to their liking. People were being asked about their preferred foods. A new chef had started and intended to make improvements to take more account of people’s choices.

People were supported to manage their health care needs and were supported to access health care professionals as appropriate. A physiotherapist employed at the service had developed personalised plans with people to promote their health and improve their physical wellbeing.

People said, “The staff are very kind and caring.” Staff were kind, caring and patient in their approach and had a good rapport with people. Staff supported people in a calm and relaxed manner. Staff initiated conversations with people in a friendly, sociable manner. Our observations contrasted with some people’s comments that the staff were often too rushed to help them. We observed staff stopping to chat to people and ask if they were alright and if they needed any help.

People were supported to remain as independent as possible. The staff encouraged people to care for themselves when they had been assessed as able to do so. One person managed their own medicines and staff supported them to do so safely.

The home was generally suitable to meet people’s needs and some adaptations had been made to assist people living with dementia such as appropriate signs and individual door colours. The staff had already recognised a need to further adapt the home and had made some plans to do so. We have made a recommendation related to this aspect of the service.

Staff showed respect for people’s dignity and were careful to protect people’s privacy. People told us they were treated with dignity and respect. People’s personal information was treated confidentially.

People knew who to talk to if they were unhappy about anything. People said they were listened to and their complaints had been dealt with to their satisfaction. The manager told us about the most recent complaints and how these had been responded to.

Some people told us they knew about and had been involved in their care planning. For others, their relatives said they had been consulted. The care plans included an assessment of people’s individual needs and the risk associated with their care. The plans included detailed guidance for the staff in how to meet people’s needs and this was also communicated during daily staff handover meetings. The care plans had been updated and reviewed so staff knew how to provide appropriate care and treatment as people’s needs or health changed. The staff knew people well and they were able to describe people’s preferred routines and how they liked to be helped and treated. Staff knew how to communicate with people who had communication difficulties.

People were supported to maintain their relationships with people who mattered to them. Visitors were welcomed at the service at any reasonable time and people were able to spend time with family or friends in their own rooms or the communal lounges. Most people spoke positively about the home and told us they found the management team helpful. One relative said, “They are always open to anything we say”.

Quality assurance systems had been used to recognise shortfalls in the service. Action plans had been developed and were in the process of being implemented. Meetings had taken place to hear the views of staff, people and their relatives and action had been taken as a result of people’s views. We have made recommendations for further improvements to the service.

Staff understood their roles and responsibilities and they knew who to report to and how they could access support or training. The two deputy managers had managed the day to day operations of the home for people in the absence of a registered manager.

We recommend the provider seeks further guidance on providing activities that meet people’s individual need for social interaction and occupation.

We recommend that the provider explores ways of improving the environment specifically taking into account best practice guidance on adaptations suitable for people living with dementia.