This inspection took place on 16 January 2018 and was unannounced. We announced our return to the home on 17 January 2018.

The Priory Care Home is a ‘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. Priory Care Home is registered to provide accommodation for up to 30 people, including older people and people living with dementia. On the day of our inspection 28 people were living at the home. People have access to communal areas within the home and access to the home's gardens.

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. A registered manager was in post and supported the inspection process over the two days of the inspection.

At our last inspection on 01 December 2015, we gave the service an overall rating of Good. At this inspection, we have rated the key questions Safety, Caring and Well-led as Requires Improvement which has meant the overall rating has changed to Requires Improvement.

The provider had not fulfilled their regulatory responsibilities in submitting notifications about people’s deaths to us. This meant they were in breach of Regulation 16 of registration Regulations.

There were aspects of the provider’s and registered manager’s quality checking arrangements which were not consistently effective in identifying practices which required improving to show continual development of the service.

We found staff did not always promote or maintain people's dignity. People’s personal information was not consistently stored and or when staff were working on care documents they were left in communal areas so unauthorised people could potentially access these thus not maintaining people’s confidentiality.

People benefitted from being supported by kind and caring staff who assisted people to be as independent as possible and involved in their care.

People's individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. People’s medicines we made available as prescribed and were supported to take these by staff who had the knowledge to do this in a safe manner. The registered manager had identified shortfalls in safe medicine storage for people's prescribed creams and had taken action to remedy the situation.

People were supported by staff who knew how to reduce the risk of infections and people were complimentary about how clean the home environment was and from any unpleasant odours. The registered manager took immediate action to remove a shower chair and ensured slings were for personal to each person to further assist in the prevention of cross infections.

There was evidence of organisational learning from significant incidents and events. Formal complaints were rare and any informal concerns were handled effectively with learning taken to continually improve care.

Staff worked well together in a mutually supportive way and communicated effectively. Training and one to one support systems were in place to provide staff with the knowledge and skills they required to meet people's needs effectively. There were sufficient staff to meet people's care and support needs without rushing.

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

People were provided with food and drink of good quality which they enjoyed and met their individual needs and preferences. Staff worked closely with l

This inspection took place on 1 December 2015 and was unannounced.

The provider of The Priory Care Home is registered to provide accommodation and personal care for up to 30 people. At the time of this inspection 29 people lived at the home.

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.

Staff obtained people’s consent before providing them with support by asking for permission and waiting for a response, before assisting them. People’s liberty was not restricted and the registered manager had followed the legal requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS) where people’s safety needed this.

People told us they felt safe living at the home. People were kept safe because the registered manager and staff understood their responsibilities to identify and report potential harm and abuse. The registered manager consistently reviewed accidents and incidents to reduce the possibility of people being harmed. Risks to people’s health and wellbeing were known by staff and well managed. The registered manager and staff maintained close links with external health care professionals to promote people’s health.

People and staff said there were sufficient numbers of staff available to meet people’s needs. The registered manager kept staffing levels under review alongside people’s individual needs to reduce risks to people’s wellbeing. The registered manager made all the appropriate checks on new staff’s suitability to work at the home. People’s medicines were managed, stored and administered by staff who had received the training to promote safe practices.

Staff understood people’s needs and abilities because they read care plans and received an induction where they shadowed experienced staff until they knew people well. Staff received training and support to develop their skills and knowledge. Staff had opportunities to reflect on their practice and learn from other staff so that people’s needs were effectively met and promoted.

People were offered meals which were suitable for their individual nutritional needs and met their preferences to keep people healthy and well. People told us the meals were good and were supported to eat and drink enough by staff who understood the importance of assisting people to maintain a balanced diet.

People were cared for by staff who knew them well and who they described as kind and caring. Staff knew about people’s individual preferences for care. Staff respected people’s dignity and privacy and responded to people’s likes and dislikes to support people in following their own interests. Staff made sure people obtained advice and support for health professionals to maintain and improve their health or when their needs changed.

People knew how to raise any concerns and who they should report any concerns to. The registered manager responded to people’s complaints and took action to improve the service as a result of complaints.

The registered manager was aware of their responsibilities and had developed systems to monitor the quality of the service people received. There was evidence of learning from incidents and investigations took place and changes were put in place to improve the service people received. The registered manager was continually looking at how they could provide better care for people. In doing so they valued people’s views about the services provided and used these to drive through improvements and further develop services people received.

The Priory Care Home provided care for older people. During this inspection we spoke with fifteen people who used the service, three relatives, three staff and the registered manager.

People we spoke with were complimentary about the care and support that they received. People told us, ‘I really enjoy it here, the carers are wonderful’ and ‘The staff are brilliant, very caring’.

We found that proper steps had been taken to ensure that individualised care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff had been recruited in an appropriate way and checks had been undertaken that ensured they were suitable to care for vulnerable people.

We found that any comments and complaints people made had been responded to appropriately and ensured that people were listened to.

On 17 and 19 April 2012 we inspected The Priory Care Home. During that inspection we had concerns about the management of medicines and how staff were supported with their training and supervision.

Following that inspection, we issued compliance actions to ensure that the provider took action to comply with the regulations in order to protect the health, safety and welfare of people who used the service.

We received an action plan from the provider detailing the actions they were going to take and when they planned to achieve compliance.

On 11 October 2012 we carried out an inspection at The Priory Care Home to see if the provider had complied with the compliance actions.

During this inspection we spoke with the manager, the deputy manager and two other members of staff.

We found that action had taken place with regard to improvements to the management of medication and supporting staff and that the provider was compliant.

When we visited The Priory we found that people had been treated with respect and their dignity and choice had been considered by staff.

While at The Priory we observed people’s care and support to help us understand the experiences of people living at the service. We spent time talking with several people in the lounge, the dining room and in some people’s own bedrooms.

We saw that members of staff helped people to walk as well as encouraged people with meals. There was a friendly and relaxed atmosphere within the service.

Staff were seen to courteous and respectful. Staff knew people living at the home well as they were able to tell us details about their likes and dislikes. One person told us that staff are “always there for us” and that they were “willing to help”.

At the time of our visit the service had recently introduced new care plans and risk assessments. The care plans covered a range of areas of potential need such as mobilisation, diet, elimination, oral health and well being as well as other personal care tasks. We saw evidence of monthly reviews involving the person’s key worker. One person living at the service confirmed that staff had shared the contents of her care plan with her.

We spoke with care staff on duty and they had a good understanding of their responsibilities to report actual or potential abuse within the service.

We found medicines were being stored securely. There was no system in place to monitor the temperature of the room where medicines were stored to ensure that were kept in line with manufactures instructions for the safe keeping of items. The medication trolley was clean and well organised which made items easy to find.

We carried out some audits to ensure that the number of tables remaining balanced with the records maintained. On the majority of occasions we were able to balance the number of tablets or other medicines remaining against the records. This was not however always the case. The records did not show the carry forward amount for each item although the homes internal audit did assist in some incidents.

We looked at the information which was available regarding moving and handling. The home had had two members of staff able to train care staff however their own certificates ran out at the end of April 2011 therefore almost one year prior to our visit. The manager informed us that staff should receive an up date in moving and handling on an annual basis. The records seen showed that one member of staff last received training in September 2007. A further two members of staff received training during September 2009 and another one during April 2010.

An undertaking was given to us that training would be arranged and that a full audit of training would be undertaken to see whether any other shortfalls in core training requirements could be identified.

We were informed that satisfaction surveys were recently sent out to people’s relatives. These had not been collated at the time of our visit. The feedback within those we saw was generally positive. Some concerns were apparent regarding the laundry however the service was already aware of these issues and working to resolve them.

We spoke with people who live at The Priory, who told us that they were happy at the home and that the staff looked after them well.

We observed some interactions between staff members and people living at The Priory. Staff were seen to be respectful and kind. One person told us that staff ‘always look after me’. Other people were equally complementary about members of staff.

We saw evidence that the home requests support from medical professionals as needed in order to met people’s health care needs.

Care plans were in place however the ones available to care workers were not always the most up to date version and therefore potentially contained different information. Other records completed by care workers contained gaps and did not always evidence that personal care needs were carried out.

Staff had received in-house training to ensure they had knowledge about their responsibilities regarding safeguarding people against abuse. Recruitment procedures were carried out to check staff suitability to work with vulnerable people.

We found that there is a risk that people do not receive medication as prescribed, because the home was not ensuring that records were accurate and that staff completed them fully.

Systems to ensure that the home was providing a safe service were not effective.