Archived: Preston Private

Updated 25 December 2020

The inspection

We carried out this focused 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 Care Act 2014.

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

Three inspectors and one Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Preston Private is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with CQC. This means that they and the registered provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service, including information from the registered provider about important events that had taken place at the service, which they are required to send us. We sought feedback from the local authority. The registered provider was not asked to complete a registered provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with four people who lived at the home about their experiences of the care provided. We spoke with 11 members of staff including the registered manager, deputy manager and the regional director on the inspection. We spoke with nine relatives over the phone. We reviewed a range of records. This included 11 people’s care records, multiple medication records, accident and incident records, two staff recruitment records, rotas and staffing records and we looked at a variety of records relating to the management of the service.

After the inspection

We continued to seek clarification from the registered manager, the regional director and two other directors to validate evidence found. We spoke to 17 staff members via telephone. We looked at training data and quality assurance records and sought feedback from health and social care professionals.

Updated 25 December 2020

About the service

Preston Private is a nursing home providing personal and nursing care to 58 people aged 65 and over at the time of the inspection. The service can support up to 109 people across four units. One of the units specialises in providing care to people living with dementia.

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

People and their relatives told us they felt safe living at the home. However, our observations in two parts of the home showed people could not be assured of their safety because there were times when there were not adequate numbers of staff to supervise them safely. The system for deploying staff did not robustly consider people’s presenting risks and needs. There had been an increase in unwitnessed falls resulting in fractures. Risks to were assessed and in some cases, actions had been taken to reduce the risk however, this was not always consistent.

Staff were recruited safely. Medicines were managed and administered safely. Infection prevention protocols were in place and we were assured by measures in place including measures to reduce the risks associated with COVID-19. Safeguarding procedures were in place to protect people from the risk of abuse, and to educate staff on how to recognise and respond to concerns.

We found on this inspection some inconsistencies in applying audits and quality monitoring tools, such as those that determined staffing levels and those that acted on staff feedback. The provider’s systems and processes for ensuring the deployment of adequate numbers of staff were not robust to effectively monitor, respond to people’s needs and reduce known risks. We received mixed feedback from staff regarding management support and the impact of staffing levels in the home. Staff told us,“People are having to wait longer for help and for their medicines some nights, we have shared this with management we are told there is enough staff.”

The registered manager used a variety of methods to assess and monitor the quality of the service. They worked in partnership with a variety of agencies to ensure people's health and social needs were met.

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

Rating at last inspection and update:

The last rating for this service was good (published 18 December 2019)

Why we inspected

The inspection was prompted in part due to concerns received about people experiencing falls and sustaining serious injuries and staffing levels in the home. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Preston Private Nursing Home on our website at www.cqc.org.uk

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 coronavirus and other infection outbreaks effectively.

Enforcement:

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold register providers to account where it is necessary for us to do so.

We have identified breaches in relation to keeping people safe from risks and deploying suitably qualified staff at this inspection.

Follow up

We will request an action plan from the registered provider to understand what they will do to improve the standards of quality and safety. We will work alongside the registered provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.