We carried out this inspection on 16 May 2017.

The Priory Care Home provides care for a maximum of 52 people. At the time of our inspection there were 43 people who lived at the home. The service provides care to older people and people with physical disabilities. It also provides end of life care, convalescence and respite care. The home consists of two floors with the ground floor mostly people with residential care needs and the first floor mostly people with nursing care needs.

The service 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. The registered manager had been registered since July 2016.

Care plans contained detailed information for staff to help them provide personalised care, were up to date and accurately reflected people’s care needs. People were involved in reviews of the care provided.

People told us they felt safe living at the home. Staff had a good understanding of what constituted abuse and knew what actions to take if they had any concerns. Staff were effective in identifying risks to people’s safety and in managing these risks.

There were enough staff to care for the people they supported. Checks were carried out prior to staff starting work to reduce the risks of unsuitable staff working at the service. Staff received a comprehensive induction into the organisation, and a programme of training to support them in meeting people’s needs effectively.

People and relatives told us staff were friendly, caring and had the right skills and experience to provide the care required. People were supported with dignity and respect and people were given a choice in relation to how they spent their time. Staff encouraged people to be as independent as possible and used specialist equipment to assist them to do this where possible.

People received medicines from trained staff, and medicines were stored, administered and disposed of safely.

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.

People were supported with their nutritional needs and were offered choices. Feedback was sought from people so the meal time experience could continually be reviewed. People were assisted to manage their health needs, with referrals to other health professionals when required. Staff worked in conjunction with professionals to support people with their care.

People had enough to do to keep them occupied with group activities and staff supported people with their individual interests. Further activities were being developed including some day trips.

People knew how to complain and were encouraged to share their views and opinions about the service they received. There were formal opportunities for people and relatives to feedback any concerns through meeting and surveys. The registered manager was pro-active in acting on any suggestions made.

People and relatives were positive about the management of the service. There was a positive culture where staff could raise any concerns or issues with the management team, who were approachable and responsive. There were formal opportunities for staff to do this at meetings.

There were processes to monitor the quality of the service provided. There were other checks which ensured staff worked in line with policies and procedures. Policies were being reviewed in relation to equality and diversity to ensure they were inclusive for people. Checks of the environment were completed and staff knew the correct procedures to take in an emergency.

We visited The Priory Nursing Home to follow up concerns we found when we carried out an inspection on 07 May 2014. At this inspection we set compliance actions as we had concerns that there was insufficient staffing and the systems that monitored the quality of service were not effective.

At this inspection we found improvements had been made in relation to monitoring and assessing the quality of service, however, we still had concerns regarding staff levels within the home.

We looked at the improvements made by the registered manager who had recently left the service, and we spoke with the new manager who had replaced the registered manager. At the time of our visit the new manager had been in post less than one week. The manager explained to us the steps they had taken that improved the service people received. They also explained to us how they planned to address the concerns with staffing levels and the deployment of staff within the home.

During this inspection we spoke with a visiting BUPA registered manager, one care team leader, six members of care staff and a maintenance person.

At the time of our inspection there were 40 people living at the home. We spoke with three people and four relatives of people who used the service to seek their views and experiences of what it was like living at The Priory Nursing and Residential Home. Comments people made to us were: “I like it here, the staff are good. The maintenance person is very good. “They work very hard but I do sometimes think there are not enough (staff).” “Sometimes they are a little short staffed…other than that you can’t fault it.”

We looked at staffing levels and staff deployment within the home and found we still had concerns. The manager told us they had not had an opportunity to establish what the staffing levels should be within the home.

The provider had an effective system in place that made sure people received care and support in an environment that met their needs. We saw a range of audits had been completed that made sure people were kept safe and any potential risks to them were minimised. Where improvements were required we saw actions had been taken that led to improvements.

At the time of this inspection, neither of the two people named in this report was the manager.

Two inspectors carried out this inspection on Wednesday 7 May 2014. We visited the service from 12pm to 9pm. We spoke with the manager, four visiting relatives, seven people who used the service and nine nursing and care staff. The evidence we collected helped us to answer five key questions; is the service safe, effective, caring, responsive and well led?

The service is managed by Jennie Mitchell. The other manager identified at the front of this report no longer works at The Priory. They have yet to cancel their registration.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

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

Is the service safe?

We inspected staff rotas and talked with staff and people who lived at The Priory. We saw there were sufficient staff to meet the needs of people who lived on the ground floor. We saw there were not enough staff to support the higher dependency of people who lived on the nursing floor. We also saw an over reliance on agency staff and bank staff. This meant people were at risk of not getting consistent care on the nursing floor.

The provider and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There was no one living at The Priory Nursing Home who had a current DoLs in place.

We looked at the premises. We saw the premises were secure and in good order. We looked at equipment used by staff. We saw equipment was also in good order. We noted some actions identified by the service to improve the premises and equipment had not been carried out.

Is the service effective?

People had individual care plans which set out their assessed care needs. These provided staff with the information they needed to support people with their care. Assessments included people’s needs for equipment, nutrition and personal care. We saw some daily care records such as positional charts had not been fully completed. This meant we could not be sure whether some care tasks had been undertaken.

Is the service caring?

People told us they were supported by staff who were kind, caring and patient. One person told us, “Staff are kind, the care is very good.” We observed staff on both floors to be patient, kind and respectful with people living at The Priory.

Is the service responsive?

People had access to a range of health care professionals, including a GP who visited the service weekly. We saw people were encouraged to take part in activities, and there was good provision for individual and group activities.

Is the service well-led?

The organisation did not use a staff dependency tool to determine the needs of people living in the home. We saw the organisation determined the number of staff on duty by the number of beds being used. The level of care staff did not reflect people's support needs.

We saw some of the quality audits and safety audits had not been carried out in a timely way, and actions from previous audits had not been completed. We found audits for fire safety, general maintenance and water quality identified improvements were needed but actions had not been taken.

We started our inspection at 1.30pm and finished at 7.40pm. During this time we spoke with five people who used the service, five relatives and friends of people, six staff and the deputy manager.

People living at The Priory told us,

"I love it...it's a lovely place".

“The care is very good indeed…all the carers seem to care".

“It’s very relaxing, and they (staff) show concern”.

Relatives told us,

“They’ve all been lovely here…care staff have made every effort with x”.

“Smashing…I think x is really well looked after here”.

We looked at food and nutrition. The service provided people with a good menu tailored to their wishes and nutritional need.

We looked at the care and treatment provided to people. We observed staff providing care in a friendly and caring way. Staff knew the needs of people they were supporting, and care plans reflected the care being provided. People provided with a range of activities to meet their needs.

We looked at staffing levels. We were satisfied there were sufficient staff to meet the needs of people living at The Priory.

We asked staff if they felt supported to do their job. Staff told us they were given good training, and good support from the management team.

We looked at maintenance records and equipment checks. We were satisfied that staff were undertaking appropriate and timely checks on the building, electrics, water, gas, and on equipment used by people to keep them safe.

We spoke with four people who lived at The Priory and six visitors. The majority of people we spoke with were very satisfied with the care they or their loved one received. Typical comments included:

“I can’t praise staff highly enough, they put you at ease, they make you comfortable.”

“As a family we think it’s great, x is far more relaxed then x has been in years.”

“They look after me very well and have pulled me around from where I was.”

We noted the service had a full and varied programme of activities on offer for people. During our visit we observed people taking part in activities and enjoying the experience.

We observed staff working well with each other and having fun with people living at the home. We also observed staff being gentle and kind to very sick people.

We looked at how the service managed medication. We were satisfied it was managed competently and people were safe.

We saw good recruitment systems in place to ensure staff are safe to work with people. We noted some gaps in staff files of information required by Schedule 3 of the Health and Social Care Act 2008.

We looked at how the service responded to any formal and informal complaints. We were satisfied complaints were taken seriously and responded to in a timely way.

The inspection took place on 2 December and 3 December 2014. It was an unannounced inspection.

The Priory Nursing and Residential Home provides residential and nursing care to older people with dementia. It is registered to provide care for 60 people. The home has two floors with nursing care provided on the first floor. At the time of our inspection there were 36 people living at the home.

At our last inspection in September 2014 we identified concerns with the number of suitably qualified and skilled staff providing care to people. At this inspection we found improvements had been made.

This home is required to have 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 and associated Regulations about how the service is run. At the time of this inspection there was not a registered manager in post although the process for registering the manager had commenced.

People who lived at the home, relatives and staff told us people were safe. There were systems and processes in place to protect people from the risk of harm. These included robust staff recruitment, staff training and systems for protecting people against risks of abuse. Risks to people were minimised because people received their care and support from suitably qualified staff in a safe environment that met their needs.

People told us staff were respectful towards them and we saw staff protected people’s privacy and dignity when they provided care. Staff were caring to people throughout our visit.

People told us there were enough suitably trained staff to meet their individual care needs. We saw staff spent time with people and provided assistance to people when they needed it.

Staff understood they needed to respect people’s choice and decisions if they had the capacity to do so. Assessments had been made and reviewed about people’s individual capacity to make certain care decisions. Where people did not have capacity, decisions were considered in ‘their best interests’ with the involvement of family and appropriate health care professionals.

The provider was meeting the requirements set out in the Deprivation of Liberty Safeguards (DoLS). At the time of this inspection, no applications had been authorised under DoLS for people’s liberties to be restricted. The registered manager was aware of the recent changes and had submitted applications to the appropriate bodies to make sure people continued to receive the appropriate levels of support.

People’s health and social care needs had been appropriately assessed. Pre assessments were completed before people received care at the home. The manager told us this helped them to make sure people’s individual needs could be met before people moved to The Priory. Care plans provided detailed information for staff to help them provide the individual care people required. Risks associated with people’s care needs had been assessed and plans were in place to minimise any potential risks to people.

There was a procedure in place for managing medicines safely.