This inspection of Priory Grange Care Home Limited took place on 11 and 15 January 2018 and was unannounced.

Priory Grange Care Home Limited 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.

Priory Grange Care Home Limited accommodates 41 people in one adapted building. It is in a residential area of the city of Hull. It is a two storey building with en-suite bedrooms and communal lounges, dining rooms and bathrooms on both floors. A small enclosed garden to the rear of the property is accessible to people via a ramp.

At the last comprehensive inspection in November 2016 the service was in breach of Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At that inspection the service was rated 'Requires Improvement'. These breaches in regulations were with regard to person-centred care, safe care and treatment and good governance.

In respect of regulation 9, care plans contained insufficient detail on people’s mental health, personal care, pressure relief and nutrition. For regulation 12, risks were not managed in respect of medicines, as we found that people’s pain relief patches had not been given at the right time, medicine stock controls were ineffective, there were no protocols for ‘as required’ medicines and records kept on medicines were poor. Risks were not managed in respect of infection control as we found that hand-washing and clinical waste facilities were poor, commodes were dirty, laundry flow was ineffective, toiletries were poorly stored and equipment and furniture was dirty. Risk assessment documentation was insufficiently detailed. In respect of regulation 17, audits had failed to identify the issues found on inspection and so were ineffective.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the service delivery so that the regulations were met.

At this inspection in January 2018 we rated the service as ‘Good’.

We found improvements were made with the service in that care plans had been re-written, care was provided according to people’s assessed needs and risks, the management of risk was improved and audits were more effectively used to identify shortfalls in service delivery. Therefore the provider was no longer in breach of regulations 9, 12 and 17. However, we found that the service was without a registered manager.

The provider was required to have 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 2008 and associated Regulations about how the service is run.

At the time of the inspection the registered manager had just left their employment with the provider following a mutual understanding and agreement. An acting manager (who we have referred to as the manager throughout this report) was covering the vacancy, though they had taken a position as deputy manager just three months before this. A team leader was acting as the deputy manager and together they were the management team. The provider discussed the situation with us and explained that the manager would be submitting an application to register and the registered manager would be submitting an application to de-register. The provider had sent a notification to the Care Quality Commission about the registered manager’s absence. They told us they would send another because the registered manager had now left their position. However, because there was no registered manager in post the Well-led section cannot be rated better than 'requir

Priory Grange is registered with the Care Quality Commission (CQC) to provide care and accommodation for a maximum of 41 older people, some of whom may be living with dementia. The accommodation is provided over two floors and all bedrooms are en-suite. There is a passenger lift so people with limited mobility can access the upper floor easily. Corridors are wide enough to accommodate wheelchair users as are doors to all bedrooms, bathrooms, toilets and communal areas. There is choice of communal areas where people can spend their time one of which is currently being refurbished and will include a bar area for people who use the service and their friends and families to socialise.

All toilets and bathrooms are large enough to accommodate wheelchair users easily. Various aids and adaptations are provided around the building to assist people to remain independent and aid their mobility. Staff have access to equipment to enable them to assist people to move safely.

This inspection took place on 21 and 23 November 2016. An evening visit was undertaken on 21 November, which was unannounced. The second day of the inspection was the 23 November and was announced. The reason we undertook an out of hours inspection was because some allegations had been made that people were in bed early against their will; the outcome of this will be covered in the main section of the report. The service was last inspected December 2014 and was found to be compliant with the regulations inspected at that time.

At the time of the inspection 38 people were living at the service.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people’s medicines were not always handled safely and they did not always receive medicines as prescribed by their GP, including some opiate based pain killers. This could mean people were in unnecessary pain due to staff not following the GP’s instruction. We also found some mistakes when staff had hand written medicine doses on the medicines administration record; this could mean that people received the wrong dose of medicines. We found there were no instructions for staff to follow with regard to administering ‘as and when required’ (PRN) medicines. This could mean that people might get too much or too little medicine.

We found that staff did not always follow good practice guidelines with regard to the handling of items, which could pose a risk of cross infection. We found that the lids on clinical waste bins did not work properly so staff had to lift these by hand and this increased the risk of cross infection. There was no hand washing facilities in bed rooms for staff to use so they had to use a communal bathroom increasing the risk of cross infection. Some of the equipment used in people’s rooms was dirty and need of a deep clean, and some personal items like tooth brushes needed cleaning. Some chairs and beds were in need of replacement or cleaning, as was some bed linen.

Risk assessments in place did not always give clear instructions to staff about how to best keep people safe, and some people’s care plans did not contain essential information about their needs. Charts used to monitor people’s welfare, for example, food and fluid intake had not been consistently completed and care plans for people’s assessed specific needs had not been completed so were not available for staff. This could mean people were at risk of not being supported safely and kept safe from the risk of harm, and that staff might not deliver the right care to meet people’s needs. These are all breaches of regulations and you can see what we have told the registered provider to do at the end of the report.

Staff knew ho

People confirmed that their care and treatment options were discussed with them and they were asked for their consent. Relatives we spoke with confirmed that people gave their consent and that this was documented in the care record.

People’s comments included, “I am satisfied with the care and treatment,” and “You are well looked after; if you ring the belI they are here in no time, day or night. During the night you can hear them open the door to see you are all right” A relative commented, “It seems very satisfactory to us; they are very thorough.”

People who used the service spoke positively about cleanliness. People’s comments included, “Everything is nice and clean; they clean the toilet every day,” and “Cleanliness is very good; they are always working, always cleaning.” A relative commented,” Her room is very satisfactory; we have no complaints about cleanliness.” A visiting healthcare professional commented, “Cleanliness is acceptable.”

There were effective recruitment and selection processes in place. People commented positively about the staff: “The staff are all friendly, and quite happy altogether, including the night staff.” A relative commented, “The staff take care of anything we want.”

People knew how to make a complaint. One person told us, “They see to niggles and I am quite happy.” Another person said, “You just ask for one of the staff to come and see you and they would sort it out for you. I’ve had no complaints whatsoever.”

People who used the service told us their privacy, dignity and confidentiality were respected. One person told us, “You’ve got your own room which is lovely. You can do what you like. Sometimes in the afternoon there is bingo, and somebody sings. On Tuesday you get your hair washed and set.” Other comments included, “You can join in and do what you want to do,” and “I play skittles and I go out to the shop to get things for other people.”

People told us about the care they received in Priory Grange. One person told us, “I really like it here. You are lovely and warm and I feel well looked after. Even during the night you only have to press your bell and they are there.” Other comments were, “It’s all right. They care for everything. I can’t do anything for myself except feed. They come and turn me,” “I’m happy. They look after me well,” and “If I want anything I only need to ask.”

People who used the service spoke with us positively about the staff that worked in Priory Grange. Comments included, “The staff are all right. I have no complaints about the staff,” “I don’t think I have had anybody that hasn’t been nice since I’ve been in,” “Staff are not too bad,” and “All the staff are good.”

We also spoke with relatives, whose comments included, “You can’t fault it in any way. I can’t fault the staff. They know their jobs and they are friendly,” “There is no problem with the staff. They are very helpful. The staff seem to be very happy working,” and “Staff all seem pleasant and respectful.”

People spoke appreciatively of the residents and relatives’ meetings and said they felt the consultation was meaningful. One person told us, “I go to the resident meeting and it is useful. They definitely listen. If you want to say anything you can say it. I can’t remember completing any surveys. I would go to the office if I had a complaint, but I have had no complaint. I am highly satisfied.”

One person said that ‘they are lovely here’ and another had been looking forward to the entertainer who was visiting that afternoon.

We were able to talk to three people who use this service and each expressed that they were happy with the service they receive.

We spoke to three relatives during the course of this visit who all expressed satisfaction with the care given to their family members.

In addition the following comments were given during a survey of people who live at this service carried out September 2010: ‘The home provides everything I need’ and ‘Carers are very good’.

Comments on nutrition included; ‘More sugar free food as I seem to get the same pudding every day’ and ‘I enjoy all the food here’.

This inspection took place 1 and 2 December 2014 and was unannounced. The service was last inspected August 2013 and was found to be compliant with the regulations inspected.

Priory Grange Care Home Limited is registered with the CQC to provide care and accommodation for up to 41 older people who may be living with dementia.

People’s bedrooms are on two floors and all are single with en suite facilities; there is a lift to assist people to access the upper floor. Various communal areas are provided for people to use including a dining room on the first floor and two lounges on the ground floor. All bathrooms and toilets are easily accessible for people who may need support with their mobility.

People who used the service felt safe and were protected from abuse because staff had received training about how to recognise and report abuse; they also felt confident the registered manager would take the appropriate action. The registered provider had policies and procedures in place for staff to follow about safeguarding adults from harm and abuse which reflected current practise guidelines.

People were cared for by staff who had been recruited safely and who were provided in enough numbers to meet people’s needs.

People’s medicines were handled and stored safely by staff who had received the appropriate training.

People were cared for by staff who had received training about the needs of the people who used the service and how best to support them. Staff were supported to undertake further development and training.

People were provided with a wholesome and nutritional diet which was monitored by the staff. Referrals were made to health care professionals when needed and people were supported to attend hospital and GPs appointments. People who used the service were supported by staff who understood their needs. They had good relationships with staff who also understood the importance of respecting people’s privacy and dignity.

People had been involved in the formulation of their care plans and were involved with their reviews. Staff monitored people’s daily wellbeing and sought the appropriate advice and guidance form health care professionals when needed. People could choose from a range of activities.

People could make complaints or raise concerns with the registered manager and these were investigated to the satisfaction of the complainant whenever possible.

People were involved with the running of the service and the registered manager sought their views about how the service was run. The registered manager also undertook audits of the service to ensure people lived in safe, well maintained environment.