About the service: Primrose Bank is registered to provide accommodation with personal care for up to forty-five people. The property is an extended detached house situated on a main access road to Poulton Le Fylde. There are a range of aids and adaptations in place to meet the needs of people who live there. At the time of the inspection 39 people were living at the home.

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

People’s experience of using this service:

People could not be assured they would receive their medicines when they needed them as medicines were not always managed safely. Medicines audits had not identified the concerns we had identified on inspection. Prior to the inspection concluding the registered manager wrote to us. They explained they had taken immediate action to address the concerns we had found.

People were asked to consent to their care. The registered manager told us they would seek support from external health professionals if mental capacity assessments needed to be carried out. We have made a recommendation about mental capacity assessments.

Risk assessments were documented and personalised to meet individual needs. Care documentation instructed staff in how risks should be minimised.

Care records were person centred and people told us they were involved in their care planning.

People who lived at the home told us they were well cared for and were supported to see medical professionals if this was needed.

People told us and we saw, that help and support was provided quickly by staff if this was needed.

People told us they were happy with the food provided at the home and we saw nutritional assessments were carried out to identify if people required extra support.

People told us the home was well organised and staff spoke positively of the support they received from the registered manager.

People were enabled to be involved in the day to day running of the home. Meetings took place to support people in expressing their views.

People were invited to take part in a range of activities. People told us they enjoyed these.

Safe recruitment procedures were carried out and staff told us they received training and supervision to enable them to fulfil their role.

People told us they were safe and staff told us they would report concerns of abuse or avoidable harm to the registered manager and local safeguarding authorities to protect people.

Rating at last inspection: At the last inspection the service was rated as Requires Improvement. The report was published on the 7 March 2018.

Why we inspected: At our last inspection in January 2018 we identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014. We found people could not be assured that medicines were managed safely. We also noted a breach of Regulation 17 of the Health and Social Act Care Act 2008 (Regulated Activities) Regulations 2014. Care records were not always reflective of people’s needs and the audit systems in place had not identified the concerns we had found. We took regulatory action and served requirement notices for these breaches of legal requirements. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by March 2018. We carried out this inspection to check improvements had been made.

Enforcement:

Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up:

We have requested an action plan from the registered provider as to how they plan to address the breach in regulation and make improvements to the service.

The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning info

This inspection was carried out on the 09 and 10 January 2018 and the first day was unannounced.

Primrose Bank Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Primrose Bank Rest Home provides residential accommodation for up to forty-five people and is registered to provide personal care to people who live at the home.

The property is an extended detached house situated on a main access road to Poulton Le Fylde. There is a secluded garden to the side and front of the property and car parking is available at the rear of the home. There are a range of aids and adaptations provided to meet the needs of people who live there. On the day of inspection visit there were 37 people living at the home.

At the time of inspection there was a manager who was registered with the Care Quality Commission. 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.

We last inspected Primrose Bank Rest Home in March 2016 and identified no breaches in the regulations we looked at.

This inspection of Primrose Bank Rest Home was brought forward from its initial scheduled date. This was because we had received information of concern regarding the care and support people received and the safe management of medicines. We used the information we received to plan our inspection effectively.

During this inspection carried out in January 2018 we found medicines were not managed safely. We found some medicines were not recorded within the Controlled Drugs Register and there was no guidance for staff on why and when people should receive their ‘ as and when’ medicines. In addition, we found medicines were not stored safely. We found the fridge where medicines were stored did not have the minimum and maximum temperature monitored to ensure medicines were stored at the correct temperature. We noted handwritten medicine administration records were not always signed by two staff. This was a breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Safe care and treatment.)

People told us they were happy living at Primrose Bank Rest Home and the care met their individual needs. We found people were referred to other health professionals for further guidance and advice when this was required.

We found care records did not always record the up to date needs of a people who lived at Primrose Bank Rest Home. We found risk assessments on equipment to keep people safe and promote independence were not always documented. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Good Governance.)

We reviewed the audit systems at Primrose Bank Rest Home. We found the audits had not identified the areas of concern we had noted with the safe management of medicines and care records. This was a breach of Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 (Good Governance.)

We saw applications were made to ensure that where people’s rights were restricted, this was done so lawfully. We saw evidence people’s mental capacity was assessed and people were asked to consent to their care whenever possible.

During the inspection we spoke with eleven people who lived at the home. People we spoke with told us they were happy at the home and they liked the staff. People told us they were supported in the way they agreed and they enjoyed the meals provided.

People told us their privacy and dignity was respected and they took part in activities if they wished to do

The inspection visit took place on 08 March 2016 and was unannounced.

Primrose Bank provides residential accommodation for up to twenty-eight people. The property is an extended detached house situated on a main access road to Poulton Le Fylde. There is a secluded garden to the side and front of the property and car parking available at the rear of the home. There are regular transport links close by. There are a range of aids and adaptations in place to meet the needs of people who live there. At the time of the inspection visit there were 24 people living at Primrose Bank.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated Regulations about how the service is run.

At the last inspection on 14 August 2014 we found the provider was meeting the requirements of the regulations inspected.

We found the registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Staff had received safeguarding training and understood their responsibilities to report any unsafe care. One staff member said, “I would know what to do if I felt abuse was taking place.”

We found recruitment checks were carried out to ensure suitable people were employed to work at the home and there were sufficient staff to meet people’s needs. This was confirmed by talking with staff members and looking at records of staff recruitment.

Medicines were dispensed in a safe manner and people received their medicines on time. Staff had received related training to ensure medicines were administered correctly by knowledgeable staff. Controlled drugs were being administered at the time of the inspection visit. We found correct documentation was recorded to ensure accurate administration of controlled drugs.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

Staff had received training and were knowledgeable about their roles and responsibilities. Staff told us access to training courses and opportunities to develop their skills was good. One staff member said, “We are always encouraged to do more training.”

The registered manager had completed an assessment of people’s needs. People who lived at the home said they were happy with their care and support provided to them by caring staff. One person who lived at the home said, “We went through things, the staff were very good.”

People who lived at the home were happy with the variety and choice of meals available to them. The service employed cooks who prepared homemade meals and comments were positive about the quality of food. Regular snacks and drinks were available between meals to ensure people received adequate nutrition and hydration. One person who lived at the home said, “Good home cooking here.”

We observed staff treated people with respect, patience and dignity. People we spoke with told us staff were caring and respectful. One person who lived at the home said, “The staff and management are so good and kind towards people.”

Staff knew the likes and dislikes of people who lived at the home and delivered care and support in accordance with people’s wishes. During the inspection we observed people were supported to carry out activities which they enjoyed.

There was a complaints policy in place, which was understood by staff. Information on the complaints procedure was available in the reception of the home.

The management team used a variety of methods to assess and monitor the quality of the service. We looked at a number of audits that had taken

The area of non-compliance found at the last inspection had been addressed. The provider had introduced a more robust staff recruitment procedure. This meant that newly appointed people only took up their post at the home when all the required clearances and references had been received and deemed to be satisfactory. This helped to ensure that only suitable people were appointed, that had the personal qualities, skills and experience to assist and support the vulnerable people living at the Primrose Bank.

During our inspection we looked at the way people were cared for, the safe management of medicines, staff recruitment, the quality monitoring systems in place and the way complaints were handled. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. A further short visit and discussion with the registered manager took place on another day. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

This helped to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found.

Is the service safe?

People were treated with dignity and respect by the staff team. People told us they felt safe and comfortable living at the home and that staff were, “Excellent. They do all they can for you, they never get cross or anything like that. I enjoy living here”.

Medication practices were robust. Only senior staff that had received appropriate medication training had responsibility of the administration of medication. A monthly medication audit was in place. This helped to ensure that medication practices remained safe, by ensuring any shortfall was quickly identified and addressed.

The home had appropriate policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had needed to be submitted. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that people were safeguarded as required.

We looked at the recruitment of new staff. We did not see evidence to confirm that all the required recruitment checks into qualifications and experienced were obtained before the newly appointed person started their employment at the home. This potentially put people at risk of being supported by staff without appropriate skills.

Is the service effective?

There was an advocacy service available if people needed it, this meant that when required people could access additional support.

People’s health and care needs had been assessed prior to them moving into the home. This made sure that their individual needs and requirements could be addressed by the staff team. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People spoken with told us that their needs were being well met.

Visitors confirmed that they were able to see people in private and that visiting times were flexible.

Is the service caring?

People were supported by kind, caring and attentive staff. We saw that care workers showed patience, humour and gave encouragement when supporting people. People commented that staff were, “Kind and interested. They are very attentive, ask for help and you get it”. A relative told us, “I think the empathy side of things they are very good at. There does not seem to be any shortage of staff ever”.

People were being supported to dress appropriately and care was taken with their hair and clothing. This indicated that staff were aware of the importance of appearance and how this impacted upon an individual's personal dignity and feeling of self-worth.

People using the service and their relatives completed an annual satisfaction survey. Where any shortfalls or suggestions were raised these were addressed. We looked at the outcomes of the most recent surveys, outcomes were all positive.

People’s preferences, interests and diverse needs had been recorded and care and support provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. However the people we spoke with said they had never had any cause to make a complaint. We looked at the way a complaint would be handled and the records used for recording a complaint, the method of investigation and outcome. The processes in place reassured people that any complaint would be taken seriously, investigated and action taken if required.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had quality assurance systems in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

Staff told us they were clear about their role and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes in place. This helped to ensure that people received a good quality service at all times.

We spoke with a number of people about the home. They included two deputy managers, a number of staff and people who lived at the home. In addition we spoke with people visiting the service on the day. We also had responses from external agencies including social services .This helped us to gain a balanced overview of what people experienced living at Primrose Bank.

During our inspection we used a number of observational tools to gain evidence about what it was like to live at the home. We did this by looking at care records, staff training and support records, nutritional support and evidence of how the home managed quality and listened to people. In addition we spent time in communal areas including the garden in order to speak with a range of people as well as making general observations of the routines in the home.

We were visiting the home when the evening meal was being served. This was done in an unhurried way, with people seen to be exchanging conversation with each other, as well as staff communicating positively with residents throughout this time. A visitor arrived and was seen to be made to feel welcome, sitting at the dining table with their relative.

The home had a pleasant atmosphere with residents coming and going as they pleased. Comments from people included, “What lovely place to live. I am lucky to have such a nice home with lovely staff to help me.” Also, “I am always asked what I would like to eat every day, there is always a good choice”.

People we spoke with told us they liked the facilities available to them at the home. This included comments about individual rooms. One person said, “I have everything I need in here its home from home”.

We visited this home unannounced on Tuesday 22nd May 2012. During the course of the site inspection we spoke individually with the provider, two deputy managers, three staff members, a number of people living at the home, and two visitors. We spent time in various parts of the home including communal lounges, dining room and some resident’s personal rooms.

People we spoke with including residents and visitors told us staff were respectful and treated them with dignity. One person said, "I can only say, staff are very polite and caring.” Another person we spoke with told us, "Staff are always close by if you need them, they give me a hand with anything I need.” All the people we spoke with said good things about the way they were treated by all members of staff.

People we spoke with throughout the inspection process were very satisfied living at Primrose Bank. They told us it has a relaxed and homely environment. They told us they do not feel rushed and can use the home as they choose. They specifically liked the way visitors can call in at any time. We saw this occur throughout the time spent at the Primrose Bank. Two visitors we spoke with told us they were very happy with the way their relative/friend were being cared for. Comments included, “Dads only been here three days but the staff have been very good at settling him in.” Also, “Can’t fault the staff they are very good.”

Responses from staff and residents were all positive and reflected how the home is run in the best interest of people who lived there. Other comments from people included, "Dads here on respite and he has settled in really well.” Also, I call in every day so I see it at different times, staff are always around and it’s so clean.” A staff member told us, "Most of the staff have been here for a long time, it’s a good place to work, and we all support each other”