This inspection was carried out over three days on the 30 and 31 January and 1 February 2017. Our visit on 30 January 2017 was unannounced.At the last inspection on 23 and 24 November 2015 we rated the service as requires improvement overall. We identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014, which related to medication administration, consent, staff training, and good governance.
This inspection was to check satisfactory improvements had been made and to review the ratings. At this inspection we found multiple breaches of the regulations. These were in relation to safe care and treatment, consent, premises and equipment, good governance, staffing and fit and proper persons employed. We are currently considering our options in relation to enforcement in relation to some of the breaches of regulations identified. Full information about the Care Quality Commission's (CQC) regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Priestnall Court is situated in Heaton Mersey, a residential area of Stockport. The home provides support for up to twenty four people, who require help with personal care. At the time of our inspection twenty four people were living at the home. Nineteen bedrooms have en-suite bathrooms and are of single occupancy, although one double room is available for those wishing to share facilities. A passenger lift is available for easy access to the first floor level. On the ground floor the communal areas consist of an attractive dining room, two lounges, one contained a television for people to watch and there was also a quieter lounge for people to sit and talk. Car parking spaces are available to the front of the building and there is a well maintained garden to the rear of the property. A variety of amenities are within easy reach, such as shops, a library, supermarket, pub, restaurant, park and a cinema. Public transport links to Stockport town centre are nearby.
The home had a manager registered with the Care Quality Commission (CQC), who was present throughout the three days of inspection. A registered manager is a person who has registered with CQC 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.
Some medicines were not managed safely. For example we found there were not always clear, detailed written directions for the use of prescribed creams to enable staff to apply the creams as intended by their general practitioner (GP). This meant there was a risk prescribed creams may not have been applied when required, which could have resulted in unnecessary discomfort to the person and people were not receiving their medication as prescribed.
We saw that one person had not completed the full course of antibiotics that had been prescribed when they were discharged from hospital following an infection. Because of the concerns in relation to this part of medicines management we raised a safeguarding alert with the local authority. These concerns were formally progressed under the local authority safeguarding protocol.
We had concerns in relation to staff supervision. Since our last inspection staff had only received one supervision session and no staff had received an annual appraisal. This meant that staff were not being appropriately guided and supported to fulfil their job role effectively.
Recruitment processes required improvements to ensure only suitable staff were employed to work with vulnerable people.
Some of the routine safety checks in the home had not been undertaken for example the nurse call bells, portable appliance testing (PAT). Other safety checks, for example means of escape, fire alarm testing and emergency lighting had not been undertaken since November 2016. This meant the provider could not be sure people using the service were safe at all times.
We saw there were no temperature recordings of two freezer temperatures and there was no evidence of cooked food temperatures being taken prior to food being served to people. This meant there was not adequate temperature controls in place to ensure food was kept and served at a safe temperature. Due to these concerns and the potential risk to people we forwarded the information to the food safety agency at Stockport Metropolitan Council.
From looking at the training records we found there were some gaps in staff training. For example, not all staff had received food hygiene training, safeguarding adults training, moving and handling training, end of life training and infection control training.
We saw that the home had its own induction process. However there was no evidence in the staff files to demonstrate that four people who had commenced employment since our previous inspection had undertaken induction.
We saw that some people’s care needs identified from their medical history did not have a corresponding plan of care in place to direct care staff on how to meet the individual care need. This meant there was risk that people could receive unsafe and inappropriate care.
Staff spoken with understood the need to obtain verbal consent from people using the service before a care task was undertaken and staff were seen to obtain consent prior to providing care or support. However we saw that consent for some people had not been appropriately obtained from a person who had the legal authority to give consent on the person’s behalf.
Limited systems were in place to monitor the quality of service people received. For example there were no audits or reviews taking place of people’s care records, staff training, staff recruitment files, accidents and incidents and general cleanliness and infection control within the home.
During this inspection it was found that notifications in relation to an allegation of abuse, three Deprivation of Liberty safeguards (DoLS) authorisations and six deaths of people living at Priestnall Court during 2016 had not been made to the Commission.. This meant the registered manager and the registered provider had not complied with their duty to notify the Commission of required events.
People were supported by a caring staff team and staff we spoke with told us if there was no staff sickness they thought there were sufficient staff to safely meet people’s needs. However, we found there was not a systematic approach to determine the number of staff and range of skills required to meet the needs of the people who used the service. This meant the registered provider could not be sure that the staffing levels and skill mix of staff was sufficient to meet the assessed needs of people living at Priestnall Court. We made a recommendation that they implement the use of a staffing tool. A staffing tool recommends appropriate staffing levels based on people’s health and social care needs and dependency.
We saw there was a concerns and complaint policy included in the statement of purpose that was given to each person on admission to the home. The people living at Priestnall Court who we asked and the visiting relatives we spoke with told us they had never raised a complaint but thought the manager would be responsive if they did.
We saw the food looked and smelt appetising and was attractively presented with good size portions.
The home was clean and well maintained and we saw staff had access to personal protective equipment (PPE) to help reduce the risk of cross infection.
People had a personal emergency evacuation plan (PEEP) in place. These plans detailed the level of support the person would require in an emergency situation in order to safely evacuate the home.
People had access to healthcare services Including a speech and language therapist, district nurse, dentist, optician and chiropodist. We found people were supported to attend hospital appointments as required.
From our observations of staff interactions and conversations with people, we saw staff had good relationships with the people they were caring for. The atmosphere felt relaxed and homely.
We saw that meaningful activities were provided by an activity co coordinator based on people’s personal preferences.
The three visiting healthcare professionals we spoke with told us they had no concerns for the people living at Priestnall Court and they said they thought good and safe care was provided.
There were no restrictions in place on people’s movement within the home.