We carried out an unannounced comprehensive inspection of this service on 9 January 2017. After that inspection we received concerns in relation to the care and treatment of people using the service, poor medicine management and lack of staffing. As a result, we undertook a focussed inspection to consider those concerns.

The team inspected the service against two of the five questions we ask about services: is the service safe and is the service well-led.

Primrose Hill Care Home provides accommodation, nursing and personal care for up to 60 older people, some of whom may live with dementia. There were 47 people living at the home at the time of our inspection visit on 24 July 2018. Primrose Hill Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection, the service was rated 'Good' overall with requires improvement in responsive. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Primrose Hill Care Home on our website at www.cqc.org.uk.

At this focussed inspection we found the area of Safe required improvement and Well-led remained Good, the service is now rated Requires Improvement overall.

Medicine management needed improvement to ensure that medicines were kept at the correct temperature to ensure their effectiveness at all times.

Individual risks although had been identified there was not always sufficient guidance to ensure staff could effectively manage those people whose behaviour may challenge themselves or others.

There was a registered manager 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.

The provider and registered manager had taken steps to improve recruitment and retention of staff and staffing levels had increased. Robust recruitment procedures helped to ensure the suitability of new staff. Training for staff was planned and monitored to ensure staff acquired and updated the skills they needed for the role.

People were protected from the risks of harm, because staff understood their responsibilities to protect people from harm and to share any concerns with the registered manager or the provider.

The registered manager checked staff's suitability for their role before they started working at the home and made sure there were enough skilled staff to support people safely and effectively.

Risks to people's individual health and wellbeing were identified and care was planned to minimise the risks. Improvements were being made to medicines management to ensure that medicines would be stored consistently at the correct temperature.

The provider and registered manager regularly checked the premises and equipment to ensure they were safe for people to use.

People and their relatives were encouraged to share their opinions about the quality of the service, through surveys and meetings.

The provider's quality monitoring system included regular reviews of people's care plans and checks on medicines management and staff's practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of re-occurrence.

Further information is in the detailed findings below.

Primrose Hill Care Home is registered to provide accommodation and care, including nursing care, for up to 60 people, some of whom live with dementia. There are three dedicated floors where people live: the ground floor is called Heron Way; the second floor is called Kingfisher Walk and the third floor is called The Mallards. At the time of our visit 60 people were living at the home.

This comprehensive inspection took place on 9 January 2017 and was unannounced.

The provider is required to have a registered manager as one of their conditions of registration. A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the CQC to manage the home. 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.

The Care Quality Commission (CQC) is required by law to monitor the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The provider was acting in accordance with the requirements of the MCA including the DoLS.

People told us they felt safe. Risk assessments were in place which gave staff the information they needed to minimise risks to people. Staff had an understanding of how to protect people from harm and knew what action they were to take if they had any concerns.

Staffing levels ensured that people received the support to meet their needs. There was an increase in the number of house-keeping staff to improve the hygiene and cleanliness of the sluice areas of the home. New staff were being recruited to fill vacancies. The recruitment practices protected people from being cared for by staff that were unsuitable to work at the home. Staff received the training and support they required to carry out their role.

Staff were kind and caring to people who they looked after. However, staff needed to take advantage of opportunities presented to them to improve the quality of their engagement with people. That said, they knew people well and were aware of their preferences, likes and dislikes. People’s privacy, independence and dignity were upheld.

People were supported to take their medicines as prescribed. Records showed that medicines were administered as prescribed. People were helped to keep well because people were had access to healthcare services when needed. People’s nutritional health was maintained: they had enough to eat and drink and nutritional supplements were provided for those people who were at risk of undernourishment.

Pre-admission assessments were carried out with the involvement of people and people who were important to them. People were actively consulted about their day-to-day care. However, there was a lack of evidence that there was a more formal system in place to review people’s care with their involvement. Activities were provided in communal areas and trips out were organised for those people who wanted to take part. However, there were times when there was a reliance on music or television to engage people in a more meaningful way. Work was in progress to improve the quality of people’s recreational activities to maintain and promote their sense of well-being.

There was a complaints procedure in place and people felt confident to raise any concerns either with the staff or the manager if they needed to.

People knew who the registered manager was and they were provided with opportunities to make suggestions about how they wanted the home to run. The registered manager ensured that the staff team were supported and had the right amount of information to do their job. In addition, there were opportunities for staff to provide feedback about any improvements that could be made, although they were unable to give examples of these. Audits were carried out with increased supervision of staff to ensure that the safet

This was an unannounced inspection. Primrose Hill Care Home provides a care and nursing service for up to 60 older people including those living with dementia. The home consists of three floor levels where people are cared for and where their needs are most appropriately met. There were 58 people living in the home when we visited.

The home had a registered manager in post. 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 and associated Regulations about how the service is run.

At our previous inspection on 6 June 2014 we found the provider was meeting the requirements of the law.

The CQC monitors the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) which applies to care services. We saw that there were policies and procedures in relation to the MCA and DoLS to ensure that people who could not make decisions for themselves were protected. We saw that staff had followed guidance and were knowledgeable about submitting applications to the appropriate agencies. Records viewed showed us that where people lacked the capacity to make decisions they were supported to make decisions that were in their best interests. People were only deprived of their liberty where this was lawful.

There was a process in place to ensure that people’s health care needs were assessed. This helped ensure that care was planned and delivered to meet people’s needs safely and effectively. Staff knew people’s needs well and how to meet these. People were provided with sufficient quantities to eat and drink.

People’s privacy and dignity was respected at all times. Staff were seen to knock on the person’s bedroom door and waiting for a response before entering and by using suitable means to protect people’s dignity when providing personal care.

Care records we viewed showed us that wherever possible people were offered a variety of chosen social activities and interests. This was observed only on the first floor. However, for people living on the second and third floors there was no impromptu social stimulation offered. People were not always supported in a way that helped prevent social isolation.

The provider had an effective complaints process in place which was accessible to people, relatives and others who used or visited the service.

The provider had a robust recruitment process in place. Records we looked at confirmed that staff were only employed within the home after all essential safety checks had been satisfactorily completed.

Checks had been completed for things such as lifting equipment and gas and electrical safety in the home. This ensured that the home was a safe place for people, staff and visitors.

The provider had effective quality assurance systems in place to identify areas for improvement and appropriate action to address any identified concerns. Audits, completed by the provider and registered manager and subsequent actions taken, helped drive improvements in the home.

The inspection team was made up of one inspector. We set out to answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

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

Is the service safe?

Staff told us that they enjoyed their work and we found they were appropriately trained. Staff we spoke with demonstrated they understood the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards so that people who could not make decisions for themselves were protected.

On the whole, Primrose Hill Care Home was visibly clean and tidy. It was evident that staff understood their responsibilities with regard to infection control. The provider told us that the carpets would be replaced in parts of the home over the next few months.

Is the service effective?

We observed good relationships between staff and people who used the service. Staff we spoke with demonstrated they understood how to meet people’s individual needs. Care plans were up to date and provided detailed information on how people wished to be supported.

We saw that care was provided in a way that was intended to ensure people’s safety and welfare. People told us they liked living at Primrose Hill Care Home. One relative commented, “My (relative) is well looked after and I have never had any concerns.”

Is the service caring?

We saw that people were supported by staff who were kind and respectful. One person commented, “The staff are very kind.” Care records contained information about people’s preferences and it was clear that people had been involved in planning their care. One relative told us, “I can not speak highly enough about the care”.

Is the service responsive?

People and their relatives told us that issues or concerns were dealt with promptly by staff. One relative told us, “I have had a few concerns but they are always dealt with. I have no complaints at all.” We looked at two recent complaints and found they had been investigated and followed up in line with the complaint's procedure.

We saw that the service worked with a range of health care professionals and ensured people received care in a coherent way. A relative told us, “I am kept very well informed. When (my relative) went to hospital I was put in the picture.”

Is the service well led?

The provider had a number of systems in place to ensure that the quality of the service was regularly assessed. Monthly quality checks took place and covered a wide range of areas to ensure people received a good service. There was evidence that the provider took action to improve the service when this was required.

People who lived at Primrose Hill Care Home and their relatives were invited to regular meetings and were encouraged to express their views. The provider told us that a questionnaire to ask people and their relatives what they thought about the service was planned for later in the year.

As the purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous review of compliance undertaken in November 2013 we did not request information directly from people using the service on this occasion.

As the purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous review of compliance, undertaken in June 2013, we did not request information directly from people using the service on this occasion.

As the purpose of this inspection was to assess improvements made in relation to shortfalls identified during our previous review of compliance, undertaken in April 2013, we did not request information directly from people using the service on this occasion.

We spoke with 14 people living in the home, four relatives, nine staff including registered nurses and the manager. Most people we spoke with said they liked being in the home. One person said, "We're all very happy here. It's very good here. They do a thorough job, get me washed and dressed and keep me happy." Another person told us, "This is the best place ever built. Staff are perfect. If you ask for a cup of tea you get one." One staff member said, "I love it here." Two staff we spoke with said they really enjoyed working in the home.

We saw that staff were caring and kind with people and included people whenever they passed and the home atmosphere was calm and relaxed. Staff liked that they worked on a single floor so they could get to know the people there.

The provider may find it useful to note that some carpets in bedrooms and corridors were discoloured and although the home was generally clean and bright there was malodour in some areas.

The provider may find it useful to note that the first aid boxes contained out of date goods such as sterile dressings and CPR face shields. The manager audited these during the inspection.

One family member said they could not speak too highly about the care their relative had received. One person said that they could choose what to wear and eat, as well as whether to be involved in activities or not. Another person said, "I like it very much. I attend resident meetings, but the entertainment (in the home) is not very good but there is some". One person said the staff, "Have a laugh", although two people commented that some were better than others in the way they provide care.

People we spoke with told us staff were polite and kind; they respect people’s privacy and address them appropriately.

People said that they liked the meals provided at the home, although some people thought they were not always warm enough.

People advised that they were able to raise concerns with staff and said they felt safe at the home.