The Priory Care Home is a residential care home for 24 older people. People’s bedrooms were located on the ground and first floor with a passenger lift, ensuring easy accessibility. There are also self-contained flats, which enable greater independence for some people. The home has a communal lounge and separate dining room on the ground floor.

At the last inspection on 26 April and 4 May 2016, the service was rated as ‘Good’. At this inspection, we found the service had deteriorated to ‘Requires Improvement’.

A registered manager was employed by the service and was present during our inspection. 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.

Why the service is rated as ‘Requires Improvement’:

Not all risks to people’s safety had been properly identified or addressed. This particularly applied to excessively high water temperatures, which increased the risk of people sustaining a scald type injury. Each accident and incident had been individually reviewed and a summary of occurrences had been completed. However, the information did not show an overview, to enable potential trends to be identified.

People’s medicines were not always safely managed. Whilst people had capacity to ask for their medicines to be taken "as required", information was insufficiently detailed to ensure they were administered as prescribed. Staff had received training in the safe administration of medicines and assessments of their competency were in the process of being undertaken.

There were some aspects which did not promote good infection control. This included brown debris on a hand wash basin and used paper towels overflowing from a bin in a communal toilet. Other areas of the home, including those less visible were clean.

People were encouraged to make decisions about their day to day lives but not all were undertaken in line with the Mental Capacity Act 2005. Documentation did not always show people had consented to equipment such as monitors and bedrails or that they were the least restrictive option available.

Systems to assess the quality and safety of the service were not always effective, as shortfalls found at this inspection had not been identified.

There were enough staff to support people effectively. Staff answered call bells quickly and had time to spend with people without rushing.

Staff were aware of their responsibilities to report any suspicion or allegation of abuse. Safe recruitment practice was undertaken to ensure staff were suitable to work with people.

People had sufficient to eat and drink and enjoyed a variety of well cooked, homemade food.

Staff were well supported and undertook a range of training to help them to do their job effectively. They knew people well and were responsive to their needs.

Staff supported people in a caring and respectful manner and promoted their rights to privacy, dignity and independence. People knew how to make a complaint and were encouraged to give their views about the service they received.

People were happy with their care and there was a strong focus on going out within the community. People enjoyed a varied social activity programme.

We recommended that continued improvements were made to people’s care plans to ensure all information was sufficiently detailed. We also recommended that improvements were made to demonstrate all decision making was undertaken in line with the Mental Capacity Act 2005.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of this report.

We carried out this inspection over two days on 26 April and 4 May 2016. The first day of the inspection was unannounced. During our last inspection to the service in May 2013, we found the provider had satisfied the legal requirements in all of the areas we looked at.

The Priory Care Home provides accommodation and care for up to 24 older people. 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 throughout the inspection.

Staff knew people well and were knowledgeable about their needs. However, care plans did not reflect this knowledge and did not clearly show people’s needs and the support they required. The registered manager had identified this was an area, in need of improvement. As a result, they were implementing a new care planning format, which was expected to be clearer and more person centred.

The registered manager confirmed staff were competent in their role but had not undertaken up to date training in all areas of their work. A new training provider, which met the needs of staff and the home, had been sourced. Training courses were being arranged and staff training and development plans were in the process of being developed.

Staff said they felt valued and were well supported by each other and management. Staff received informal support on a day to day basis and met with the registered manager more formally to discuss their work. Staff worked well as a team. They said systems such as informal discussion, regular handovers and staff meetings, ensured good communication between each other and with management. Staff were aware of their responsibilities to report a suspicion or allegation of abuse and any poor practice they noted. However, the appraisal system to review staff’s strengths, weaknesses and further development was not taking place, as detailed within the home’s policy.

People’s medicines were safely managed although records did not show topical creams were always applied. People were able to tell staff when they needed their “as required” medicines but protocols for these medicines were not in place. All medicines were stored securely and administered in a person centred way.

Systems were in place to monitor the quality of the service. However, these were being developed to ensure all areas of the home were addressed. Accidents and incidents were effectively analysed to identify potential trends and minimise further occurrences. A daily walk around of the environment took place and staff were encouraged to identify and report any potential issues.

People and their relatives were happy with the service they received. There were many positive comments about staff, the overall care provided and the management of the home. People told us they felt safe and were able to follow their preferred routines, without restrictions. They said there was an emphasis on social activity and community involvement, which they enjoyed. People told us they enjoyed the food provided and had enough to eat and drink. People were offered a range of meal choices and snacks, based on their preferences.

People and their relatives were encouraged to give their views about the day to day management of the home. This was through informal discussions, “resident” meetings or the completion of formal surveys. People and their relatives knew how to make a complaint and were confident any issues would be appropriately addressed. They said there were always staff available and they received assistance quickly, when required. Staff and the registered manager confirmed sufficient staff were deployed to meet people’s needs effectively.

We spoke with five people using the service and observed people during an activity in the morning and over lunchtime. Speaking with people individually they said, "I feel safe here, people check that I'm safe", "They're very kind to me", "There is a good choice of activities", "Staff can't do enough for you", "They're wonderful" and "Excellent, very happy".

We found that people's consent was received before providing care and support. People's needs were assessed and care plans and risk assessments provided a person centred overview of how they wished to be supported. Where required people had access to a range of social and health care professionals to meet their needs.

The home was well maintained and kept in good condition. People told us their rooms were kept clean and they were happy with their accommodation. People enjoyed working in the garden and on the home's allotment.

The home was staffed by a settled staff team that knew the people well. Staff said there was always enough of them on duty to meet peoples needs. Staff received a range of training to enable them to meet peoples needs.

The home had a complaints procedure and people we spoke with said that they had not needed to make a complaint. They were confident their complaint would be addressed by the manager.

We asked people if staff responded when they rang their bell. They told us: “The staff always come quickly when I call them even at night” and “We never have to wait long”.

During our visit we spoke with four people who live at the Priory Care Home. They all told us that the staff were ‘wonderful’ and that they had no complaints.

People told us that there were a range of activities available and that they could choose whether or not to join in. One person who was very independent told us that they went out for a walk each day to visit relatives nearby or to the post office.