Priory Mews Care Home is a ‘care home’. People in care homes receive accommodation and nursing and personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The service can accommodate up to 156 people. At the time of the inspection there were 136 people living at Priory Mews Care Home. The service comprises of five separate units adjacent to each other. Beaumont and Berkeley provide residential and nursing care for 30 and 14 people respectively; Marchall and Mountenay provide care for people with nursing dementia needs for 22 and 29 people respectively; and Cressenor House cares for 41 people with residential dementia requirements. A separate house accommodates the main reception, the kitchen, the senior management team, and the administration team.

The inspection was unannounced and took place on 10 and 11 January 2019.

The service was run by a registered manager and they were present on both days of the inspection visit. 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.

At the last inspection on 6 and 7 November 2017, the overall rating of the service was ‘Requires Improvement’. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to people were not always minimised nor significant events safely responded to. Checks on the quality of the service were not sufficient to make necessary improvements. People were not always given their medicines as directed by their doctor. People were not always supported appropriately at mealtimes or treated with dignity. We required the provider to take action to make improvements. The provider sent us an action plan detailing how they planned to address the breaches of Regulations and said that this would be completed by 30 April 2018.

We also made four recommendations. These were about making sure there were enough staff available; the control of infections, adaptations to the environment and the range of activities available.

At this inspection, we found that that potential risks were assessed and managed to help keep people safe. Accidents and incidents were monitored, and lessons learned for the benefit of people. People were consistently treated with dignity and got the help they needed at mealtimes. There had been improvements to record keeping. However, shortfalls in the management of medicines remained as it could not be assured that everyone received their medicines as prescribed by their doctor. There were a number of discrepancies in medicines records including the use of ‘only when needed’ medicines prescribed for people with agitation.

This is the second time that the service has been rated as Requires Improvement.

The provider had addressed all good practice recommendations. Staffing levels were assessed and monitored to make sure there were enough staff deployed in each unit. Infection control practices minimised the spread of any infection. This included making sure each person who used a hoist had their own sling to prevent cross contamination. Changes had been made to the environment through a use of visual aids and decoration to help people living with dementia make sense of their surroundings. The activity team had been expanded so there were activity leads in each unit to undertake group and one to one activities with people to help improve their well-being.

Systems to monitor the quality of care had been strengthened but had not identified the shortfalls in the management of medicines.

A consistent staff practice had developed throughout the service whereby everyone was tre

The inspection was unannounced and took place on 5 and 6 November 2017.

Priory Mews 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. The service comprises of five separate units adjacent to each other. Beaumont and Berkeley provide residential and nursing care for 30 and 15 people respectively; Marchall and Mountenay provide care for people with nursing dementia needs for 23 and 30 people respectively; and for Cressenor House cares for 42 people with residential dementia requirements. A separate house accommodates the main reception, the kitchen, the senior management team, and the administration team. There were 137 people living in Priory Mews at the time of our visit.

The service was run by a registered manager and they were present on the days of our visit. 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.

This is the first time the service has been rated Requires Improvement.

People and their relatives told us staff were kind and caring and made people feel safe. They said staff had the necessary skills to respond to people’s needs, monitored their health and that people enjoyed their meals. However, we found inconsistency in care practices across the service which meant that people did not always receive the level of care expected.

Systems to monitor the quality of care were not effective. Staff did not always follow guidance or escalate concerns in relation to potential risks to keep people safe. Accidents and incidents were not suitably monitored to make sure that actions taken were effective. Records were not always accurate or accessible which could result in them receiving inappropriate staff support.

Staff who administered medicines had been trained in how to do so, but there were not safe systems in place for the management of medicines.

There was inconsistency in staff practice which meant that people’s dignity was not always respected and people were not always given the support they required at mealtimes.

We have made recommendations about the deployment of staff to ensure they are available in suitable number; and infection control practices; the design of the service to meet the needs of people living with dementia and the activity programme.

Health and safety checks were effective in ensuring that the environment was safe and that equipment was in good working order. Recruitment practices were robust in ensuring only suitable staff were employed at the service.

People’s health needs were assessed and monitored and the service worked in partnership with healthcare professionals to ensure people received appropriate care and treatment.

Shortfalls had been identified in staff training and plans were in place to ensure they received relevant training for their role. Staff felt well supported both informally and through formal processes such as staff meetings and supervisions.

Staff sought and received people's consent to the support they provided and in line with the principles of the Mental Capacity Act 2005. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The service had made DoLS applications, to ensure that people were only deprived of their liberty, when it had been assessed as lawful to do so.

People’s needs were assessed and a plan of care was developed which included their choices and preferences. Guidance was in place for staff to follow to meet people’s needs.

The views of people and their relatives were sought through meetings and an annual survey.