At our last comprehensive inspection in March 2017 the service was rated ‘Requires Improvement’. At that inspection we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in relation to the management of medicines and incorrect moving and handling procedures. At this inspection we found that the registered provider had addressed these breaches. At this inspection the service was rated as ‘Good’.

Priscilla Wakefield House is a care home with nursing. 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 home accommodates a maximum of 117 people. At the time of our inspection there were 108 people living at the home. There are five units in the service. Copperfield and Havisham are units for people requiring nursing care; Nickleby for residential care. Dorrit unit for people living with dementia and requiring nursing care and Pickwick for younger adults who may have dementia, brain injury or a physical disability and who require nursing care and rehabilitation.

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.

People told us they trusted the staff and felt safe in their care. People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

Staff understood their responsibilities to keep people safe from potential abuse, bullying or discrimination.

Risks had been identified and recorded in people’s care plans and ways to reduce these risks had been explored and were being followed appropriately.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately. Medicines were being audited regularly so any problems could be identified and addressed in good time.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood the principles of the Mental Capacity Act (MCA 2005) and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any healthcare needs or religious requirements people had.

People had regular access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences.

Everyone had an individual plan of care which was reviewed on a regular basis.

The complaint process and subsequent investigations were not always transparent which meant the complainant did not always know what was happening with their complaint or if changes and improvements had been made and lessons learnt as a result. We have made a recommendation about the complaints process.

People, their relatives, staff and health and social care professionals were all included in monitoring the quality of the service. They told us the home was well managed and the management were open and supportive.

The inspection took place over two days on 1 and 8 March 2017 and was unannounced. The last inspection took place on 25 January 2016 and was an unannounced responsive focussed inspection triggered by concerns raised in notifications to the CQC. At the last comprehensive inspection on the 19 February 2015 the service rating was Good.

Priscilla Wakefield House is based in Tottenham and provides residential and nursing care for up to 112 people. At the time of our inspection there were 106 people living at the service. There are five units in the service. Copperfield and Havisham for people requiring nursing care; Nickleby for residential care. Dorrit unit for people with dementia and nursing care and Pickwick for younger adults who may have dementia, brain injury or physical disability and who required nursing care and rehabilitation.

Priscilla Wakefield House requires a registered manager to be in post as part of its registration requirements from the Care Quality Commission. There was a registered manager in post but on extended leave at the time of inspection. Suitable arrangements had been made to ensure the service was safely managed and the deputy manager was filling in as an interim manager until the registered manager returned from extended leave. 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.

At our last inspection we found breaches of regulations relating to person centred care and good governance. Since this inspection the provider has addressed these issues and is no longer in breach in these areas.

People felt safe in the home and there were robust safeguarding processes in place to try and prevent harm coming to people. All staff had been on safeguarding training and knew how to report suspected abuse.

On the first day of the inspection people told us staff were rushed and we saw this throughout the inspection, on some units they had no time to spend other than on care tasks rather than the person. By the second day of inspection more staff were on shift.

The home was clean and infection control measures were being followed. Housekeeping and care staff knew how to prevent the spread of infection for people receiving barrier nursing.

Staff all had good knowledge and understanding of the principles underlying the Mental Capacity Act 2005 and had all attended training for this. Deprivation of Liberty Safeguards had been applied for where it was appropriate.

There was a choice of food and it was freshly cooked, with snacks and home-made cakes on offer in between meals. A range of drinks was on offer, recording of fluid intake was not consistent in places.

People and their relatives thought staff were caring and respected their dignity. We saw kind interactions between staff and people. Staff told us they loved their jobs and cared for the people on their unit.

Activities for people who were mobile were good. There was an improvement plan to get to know people better and provide more one to one and tailored activities for people who did not want to or could not join in group activities.

Staff felt supported, were well trained and had regular supervisions. Staff were positive about the management team and management systems were robust.

At this inspection we found a breach of regulations relating to safe care and treatment. Some medicines were managed safely but errors had been made and not reported and people were not being moved and handled safely when provided with care.

You can see what action we told the provider to take at the back of the full version of the report.

The Inspection took place on 25 January 2016. The inspection was an unannounced responsive focussed inspection triggered by concerns raised in notifications to the CQC. At the last inspection on the 19 February 2015 the service rating was Good.

Priscilla Wakefield House is a care home situated in Tottenham. It is registered to provide nursing care and accommodation for 112 people. The unit we inspected was Dorrit Unit. This is a unit for older people who require dementia nursing care.

There was no registered manager in place. We were told a new manager had been appointed but had not yet commenced their 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.

We inspected under the domains of Safe, Effective and Well-Led. Care staff and nurses on the day of inspection were able to meet people’s support needs and the provider had requested agency staff to work one to one with a person who required extra support. Staff demonstrated they knew how to report abuse appropriately and could name possible signs of abuse.

The service assessed risk appropriately and put in measures to minimise the risk.

We observed medicine were administered appropriately and nurses informed people what medicine they were taking and why. The service had put in measures to manage infection control to avoid cross contamination.

The service referred people to appropriate health care practitioners. Nurses made mental capacity assessments when necessary and there were applications made for Deprivation of Liberty Safeguards.

We observed care staff support people with their meals following speech and language therapist guidelines when appropriate. Both kitchen staff and care staff took care to ensure people had appropriate meals to meet their dietary requirements.

Staff had not received regular supervision sessions; there had been changes in the senior staff team that had delayed some staff supervisions.

There were gaps in some health care records this meant there was not always accurate monitoring of people’s health and measures to minimise risk were not being utilised.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 9 Person-centred care and Regulation 17 Good Governance.

In addition we made a recommendation regarding the frequency and content of supervision for staff.

You can see what action we told the provider to take at the back of the full version of the report.

The inspection team who carried out this inspection consisted of two adult social care inspectors and two specialist advisors a nurse and an occupational therapist. During the inspection, the team worked together to answer five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

As part of this inspection we spoke with 11 people who use the service, six relatives, the registered manager, seven staff, this included qualified staff. We also reviewed records relating to the management of the home which included, 10 care plans and daily care records.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We could not be confident that systems were in place to monitor the cleanliness of the home. We saw that the service had ensured that risk assessments were in place, however, most staff were not aware of deprivation of liberty safeguards and how this impacted on the people they cared for.

Is the service effective?

We saw that people had access to other healthcare professionals when they needed. Staff had completed training in a number of areas to increase their knowledge and skills.

Is the service caring?

People we spoke with told us that staff respected their privacy and dignity. However, we were told by people and relatives that staff did not always meet their needs.

Is the service responsive?

We saw that people were referred to other healthcare professionals, such as, physiotherapist and dietician, however, of the care plans that we reviewed these were not person centred.

Is the service well-led?

Staff we spoke with showed that they understood the needs of individual people they cared for. Systems were in place to monitoring the quality of the service, however, these were not always effective and the provider could not be sure that people were protected from the risk of unsafe or inappropriate care.

We spent time in all five units in the home. There were 63 people living in the home at the time of our inspection. We spoke to people in four units.

People told us they liked the home, got on well with staff and felt they were well cared for. One person told us, "When I came here I was expecting the worst but the people are nice."Another person said, "It's nice here, the people are nice."

People said they liked the food. One person said, "The food is all right. They ask what I want." Another said, "They do the best they can." A third said, "I like the food, I enjoy it. They look after me." Another said the chef made them a cooked breakfast every day, no matter what time they wanted it.

Some people were unable to tell us what they thought about the home. We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to the relatives of two people, who told us they could visit any time they wanted and were happy with the standard of care provided. One person thought they could benefit from more staff but had no concerns about the care provided. This person said, “I couldn’t be happier. Some of the carers are good, but some really go over and above.”

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We used this in three units. We found that people were contented and staff engaged with them in a senstive and supportive way to meet their needs.

At the last inspection of the home in February 2012, we made a number of compliance and improvement actions. Magicare Ltd told us they had made all the necessary

improvements. We checked on these same things at this inspection to ensure the

improvements had been made.

We spent time in all five units in the home. We spoke to people in four units. Some people were unable to tell us what they thought about the home, so we observed them and their interaction with staff to see their experience. We also spoke to three relatives who were visiting the home during our visit.

At the last inspection of the home in October 2010, we made a number of compliance and improvement actions. Magicare Ltd told us they had made all the necessary improvements. We checked on these same things at this inspection to ensure the improvements had been made. We also talked to staff on duty.

People said they thought they were looked after well and they liked the staff. They thought staff were kind and caring. People said they liked the food and the activities on offer. Two people said they would like more activities to occupy their time.

We observed the majority of staff treated people with respect, were caring and supportive.

We talked to people living in the home and spent at least one hour in each unit observing the care and lifestyle that people experience. We also spoke with some people outside the home who visit regularly. Overall the feedback was that people are provided with a good standard of care, seem to be settled in the home, are given choices and have the opportunity to form good relationships with staff. Staff ask them what their needs and wishes are. People said they would like more to do as their activity needs were not being met at the time of this review.

We carried out an unannounced inspection on the 19 February 2015 and announced inspection on the 23 February 2015.

Priscilla Wakefield House provides residential and nursing care to up to 112 people. At the time of our inspection there were 101 people living at the service. There are five units in the service. Copperfield and Haversham for people requiring nursing care; Nickleby for residential care, Dorrit for people with dementia and nursing care and Pickwick for younger adults who may have dementia, brain injury or physical disability and who required nursing care and rehabilitation.

There is 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.’

At our last inspection on 23 June 2014 we found several breaches relating to respecting and involving people who used the service, care and welfare, cleanliness and infection control, and staff support. We told the provider to take action to make improvements. We received an action plan from the provider stating that these actions would be completed by end of November 2014.

Since our last visit in June we found that the provider had made a number of improvements and met the actions detailed in their action plan. We saw that the provider had implemented a new cleaning system to ensure that cleanliness and infection control practices were adhered to. Staff had received regular supervision and relevant training in DoLS (Deprivation of Liberty Safeguards) and the Mental Capacity Act 2005 (MCA). The registered manager and staff had worked closely with the local authority quality team to improve the quality of care at the service and staff knowledge of DoLS and the MCA. This included the introduction of a DoLS/MCA champion. They had employed an additional activities coordinator in September 2014, bringing the total activities coordinators to four. New care plans and risk assessments had been implemented and we saw evidence of these on the day of our visit.

We saw some good interactions between staff and people living at the service. People and relatives told us that staff were caring and kind. People were given choice and their individual needs were being met by the service. Staff were caring and kind when interacting or assisting people with personal care.

People were treated with dignity and respect and their privacy maintained. We saw that staff knocked on people’s doors and gave people time to respond before entering.

People consistently received their medicines safely and as prescribed.

Staff told us that there had been improvements since our last inspection. They said that they had received regular supervision and felt supported by their manager.

People had their nutritional needs met by the service and referrals to other healthcare professionals to assist staff to meet their needs.

Systems for monitoring the quality of the service were effective. The provider had employed an external auditor to review the standards of care. Their last report produced in January 2015 had highlighted areas for improvement. We found these matters had been addressed on the day of our visit.

The registered manager is aware and has identified further improvements to ensure people’s care plans were updated following a change in their need. Forms used to assess people’s mental capacity required further review to ensure the information was accurate and made clear whether people had given consent and who was involved.

We found the provider was in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to consent. You can see what action we told the provider to take at the back of the full version of this report.