About the service:

We carried out an unannounced comprehensive inspection of St Wilfrid’s Priory on 2 and 3 April 2019. St. Wilfrid’s Priory is a ‘care home’ that provides care for a maximum of 24 older people, some of whom of living with dementia. At the time of the inspection 15 people were using the service.

People’s experience of using this service:

People were not all able to tell us verbally about their experience of living there. Therefore, we observed the interactions between people and the staff supporting them.

People were supported by staff that were caring, compassionate and treated them with dignity and respect. People received person centred care and support based on their individual needs and preferences. Staff knew about people's life history, and their communication needs.

Risks of abuse to people were minimised because staff demonstrated a good awareness of each person's safety needs and how to minimise risks of abuse for them. The environment was safe, and regular health and safety checks were carried out.

People were supported by staff who had the skills and knowledge to meet their needs. Staff understood and felt confident in their role. People’s health had improved because staff promoted healthy active lifestyles. They worked in partnership with a range of healthcare professionals and followed their advice.

People were supported in the least restrictive way possible; the policies, systems and culture in the service supported this practice.

People's concerns and complaints were listened and responded to. Accidents, incidents and complaints were used as opportunities to learn and improve the service.

People gave us positive feedback about the quality of people's care. They said the management team and members of staff were approachable, listened and acted on feedback.

Rating at last inspection: Good. (last report published 18 October 2016). However, it was rated Requires Improvement in ‘Responsive.’ This had now improved to Good.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection, the service remained rated Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

The inspection took place on 8 and 9 September 2016 and was unannounced.

St Wilfrid’s Priory is registered to provide accommodation and care for up to 24 older people with a variety of healthcare needs. At the time of our inspection, 19 people were in residence. St Wilfrid’s Priory is an historic, listed building, dating back to the 1500s. Accommodation is provided over two floors which are accessible via staircases and a lift. All rooms are of single occupancy. Communal areas include a sitting room, dining room, a courtyard area with flowerbeds on one side of the building and accessible landscaped gardens which overlook the battlements of Arundel Castle then down towards the town centre and countryside beyond.

A registered manager was 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.

People were safe living at the home and were looked after by staff who knew how to manage their risks and protect them from potential harm. The premises were not ideally suited for people living with limited mobility, however, all parts of the home were accessible via stairs and a new lift had recently been installed. Staffing levels ensured that people received care that met their identified needs. The registered manager was in the process of recruiting additional staff to work in the afternoons to improve staffing levels at this time of day. Medicines were ordered, stored, managed and disposed of safely by trained staff.

Staff were trained in a range of essential areas including moving and handling, mental capacity, pressure area care, first aid and dementia awareness. They were encouraged to study for additional qualifications. New staff studied for the Care Certificate, a universally recognised qualification. Staff received regular supervisions and attended team meetings. They understood the requirements of the Mental Capacity Act 2005 (MCA) and their responsibilities to people relating to Deprivation of Liberty Safeguards (DoLS) and put this into practice. People had sufficient to eat and drink and were encouraged in a healthy diet. They had access to a range of healthcare professionals and services. As much as possible, people’s individual needs were met in the adaptation, design and decoration of the home. Some adaptations were limited because St Wilfrid’s Priory is a listed building.

People were looked after by kind, warm and friendly staff who knew them well. One person had brought their dog to live with them when they moved into the home. People’s spiritual needs were catered for by visiting clergy or they attended church in the community. People were treated with dignity and respect. The registered manager worked closely with healthcare professionals, including the dementia in-reach team and had received advice from another healthcare professional relating to end of life care.

Activities available to people were organised, but were limited in content and regularity. Thirty hours per week was allocated specifically to providing activities, but at weekends, care staff were expected to organise activities. The home was located at the top of a steep hill, so generally people required support from staff, relatives or friends in order to access the community on foot. We have made a recommendation that the provider reviews and improves the activities available to people. Care plans contained comprehensive, detailed information about people, their personal histories, likes and dislikes and staff delivered care that was responsive to people’s needs. Complaints were investigated and managed in line with the provider’s policy.

People, their relatives and staff were asked for their feedback about the service through residen

This inspection was carried out by an adult social care inspector. The focus of the inspection was to check if the provider had taken sufficient action to meet the compliance action set at our visit in November 2013. We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

This summary is based on our observations during the inspection, discussions with nine people, two relatives, the manager, a representative of the provider, seven care staff, the chef and the activities coordinator. We also reviewed records relating to the management of the service and four people's care and health records. We observed interactions between staff and people who lived at the service for three hours during the morning and lunchtime period.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People had care plans that were detailed and provided up-to-date information about their care needs. The selection of care plans that we looked at demonstrated that people or their representatives had been consulted and that their personal needs and preferences were reflected.

We looked at the recruitment processes and found them to be safe and thorough. The service had carried out relevant checks to ensure that staff had the necessary skills and aptitudes to work with people living at OSJCT St Wilfrid's Priory. One relative said, “The staff are always very friendly, they couldn’t be better”.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Since our last visit one application had been made. The manager demonstrated knowledge of their responsibilities in respect of this.

Is the service effective?

At our last visit, we found that the provider did not have suitable arrangements in place to ensure that people's consent was appropriately obtained and acted upon. The service had taken action and we found that people's rights with regard to consent were now promoted by the service. Staff understood how people's capacity should be considered.

We found that people’s care plans were detailed and that they had been reviewed on at least a monthly basis. This ensured that the care provided was in line with their individual needs and preferences.

People expressed satisfaction with the food at the service. One said, “The food is very good”. We saw that they were offered a choice and that staff supported them to eat and drink in accordance with their needs. During lunchtime, we observed that the mealtime was well paced and allowed people the time they needed to eat their meal.

We spent time speaking with people and observing the care and support that they received. Staff demonstrated skill and experience when supporting people. One person that we spoke with told us, “It’s lovely here, I couldn’t be happier”. A relative shared, “It’s home, not a home”.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff were patient and gave encouragement when supporting people. We spoke with nine people. They were all satisfied with the care that they received. They told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us, “We have a bit of fun so that’s good”. A member of staff shared, “Every one of the residents is like my Mum or Dad”.

Is the service responsive?

People told us that they were able to raise suggestions or concerns and that they were consulted about changes in the service. Relatives told us that they were kept informed and updated if there were any issues or concerns regarding the health of their family member. We found that the service listened and responded to questions and feedback received from people, their representatives and from staff. One relative told us, “I couldn’t be happier, ten out of ten all round”.

Is the service well-led?

Since our last visit a new manager was in post. They had taken action to monitor and assess the quality of the service. Where necessary, action plans were in place or were being drawn up that detailed steps to address any identified shortfalls. The manager said, “We’ve done a lot of work but there is still more to do”. This meant that systems were in place that ensured that the quality of service was regularly monitored and assessed.

Systems were in place to make sure that the manager and staff learnt from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve.

People told us they were supported by staff who respected their decisions about their day to day care and treatment. We have asked the provider to make some improvements in the way they support people, who lacked capacity, to ensure that where required decisions were made in their best interests.

We found that people's care was based on an individual needs assessment and planned and delivered to ensure their safety and welfare. A person told us "they are very good and very attentive to our needs". We found that staff demonstrated a good understanding of people's needs and preferences.

We found that the home was clean and that there were effective procedures in place to prevent and control infection. People we spoke with told us that they were satisfied with the standard of cleanliness. A person told us "my room is nice and bright and very clean". Other people told us the standard of hygiene and cleanliness was "good".

People we spoke with told us they enjoyed the contact they had with staff in the home. We found that staffing levels were sufficient to meet people's needs and we noted that the provider was carrying out a needs assessment in relation to staffing levels in the home.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with eleven people who lived in the home, four staff, two relatives and the local community nursing team. We also gathered evidence of people’s experiences of the service by observing the care they received from staff and the interactions between staff and people.

People spoken with told us they were very happy with the care, food, activities and lifestyle in the home. One person told us "I am extremely happy with the care here. I give them full marks". Another told us " I am lucky to be here". All of the people spoken with told us they were treated with great respect and dignity. They all also told us that they were very pleased with the variety of activities on offer.

We found that the home was managing medicines well.

We saw that care was offered by staff who were well trained and supported.

Quality assurance systems were in place to ensure the service was delivered in the best interests of the people living there.