Archived: Precious Nursing & Residential Home

Updated 23 March 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 2 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The Expert by Experience spoke with people and their relatives to obtain their opinion of the service.

Service and service type

Precious Nursing & Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Precious Nursing & Residential Care Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from the local authority professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We contacted Healthwatch for information they held about the service on their records. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 3 relatives about their experience of the care provided. We spent time observing care and support in the communal areas. We observed how staff interacted with people who used the service.

We spoke with 10 staff including domestic staff, the maintenance person, kitchen staff, care staff, senior care staff, nurses, the deputy manager, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed 6 people’s care records. We looked at 4 staff files in relation to recruitment practices. We reviewed various records relating to the management of the service including training records, quality assurance reports and accidents and incidents.

Updated 23 March 2023

About the service

Precious Nursing & Residential Home is a residential care home providing personal and nursing care to up to 38 people. The service provides support to people living with dementia, mental health support needs, physical disabilities and sensory impairments. At the time of our inspection there were 25 people using the service.

People’s experience of using this service and what we found

The provider had not always made the safeguarding adults team and CQC aware of safeguarding concerns. People did not always have support to keep their belongings secure. Environmental risks were not always managed. People did not always receive their medicines safely and guidance was not always available to staff about when people needed ‘as required’ medicines. People were not always repositioned when they needed to be to promote their skin health. However, the service promoted clean hygiene practices and staff were recruited safely.

Staff had not always completed training they needed to meet people’s needs effectively. People’s health and mobility related needs were not always monitored consistently. Health professionals told us of concerns relating to their advice not being implemented. We received and observed mixed findings about people’s mealtime experiences. People’s bedrooms were not personalised unless they had support from relatives or external professionals. However, people had their needs assessed prior to them using the service.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; despite the provider’s policies in the service supporting this practice.

People could not always access their care plans to enable their involvement and empower them to ensure their needs and preferences could be understood and met. People did not always have enough clothes to wear due to poor laundry processes . However, a relative felt positive about the care a person received and we observed staff respecting people’s privacy.

End of life plans were not always in place for people. Complaints and concerns had not been recorded or acted upon. People’s care plans were not always fully personalised. Improvements were needed so people could engage in activities meaningful to them. Accessible information was needed to enable people to seek support outside of the service. However, care plans did contain information about people’s communication needs.

There was not always effective management oversight of the service. Audits had not always been carried out or used to identify shortfalls in quality and improvements needed. Accurate and complete records were not always kept. The provider had not met all of their regulatory requirements. People were not always spoken about in a positive way. However, staff felt comfortable with approaching the registered manager with concerns.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 11 January 2022 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to safeguarding, people’s safety, the safety of the premises, staffing, dignity and respect, consent and governance.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.