The inspection took place on 21 March 2017 and was unannounced. At our previous inspection on 13 April 2015 the service was meeting all legal requirements and was rated "Good."

Priory Supporting Care provides personal care to a maximum of 24 people some of whom may be living with dementia. The service is on three floors and accessible via lift and staircase. There is a large well maintained garden and a conservatory. On the day of our visit there were 22 people using the service.

There was a registered manager. 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 consistently told us they were happy living at the service. They thought they were safe, treated with dignity and respect and involved in planning their care.

The manager was innovative and passionate about dementia care. They had set up various forums to share best practice in dementia care and had been involved in developing a dementia care "Do's and Don'ts" summary document to aid staff when supporting people living with dementia. They had gained Gold standards framework accreditation for end of life care delivery. They were also a member of NAPA and had been a finalist in 2016 Health investors awards evidencing their commitment to providing person centred care.

The service had made progress in ensuring that care plans were person cantered and took account of people’s physical, social and emotional needs. Life stories were in people’s rooms in order to enable staff to effectively engage with people using the service. Activities were centred on the needs of people and included a dementia friendly environment where people could engage freely in activities such as poet therapy, interacting with the wall murals and doll therapy.

People told us they were able to express their concerns without any fear of reprisal. Complaints were managed effectively and the policy was clear and accessible to people and their relatives.

Staff were supported by means of regular supervision, annual appraisal, regular staff meetings, training and a supportive management team.

Staff were aware of the Mental Capacity Act 2005 (MCA) and how it applied in practice. They could explain the procedures in place to ensure decisions were made in people's best interests.

People were supported to have maximum choice and control of their lives. Staff supported in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to maintain a healthy lifestyle. They were offered food that met their individual preferences. For people on puree diet the chef had found innovative methods to ensure the food was appetising thereby increasing the chances of people finishing their food.

People, their relatives and staff thought there was an open culture where their concerns were listened to and acted upon.

There were effective quality assurance systems in place to ensure care delivered was continuously improved. People and their relatives and staff had an opportunity to be involved in influencing how care was delivered and improved.

The inspection was unannounced and took place on 13 April 2015. There were no breaches of any legal requirements at our last follow up inspection on 11 November 2013.

Priory Supporting Care Limited Residential Home provides 24 hour care, accommodation and personal care for 24 older people, some of whom have been diagnosed with dementia. The service supports people with all aspects of personal care and day-to-day living activities.

The service had a registered manager. ‘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 protected from abuse and harm as the service had systems to enable staff to recognise and report abuse. Medicines were administered, handled, stored and disposed of appropriately.

Staffing levels were determined by the dependency of people and there were procedures to cover for sickness and absences. There were robust recruitment processes to ensure that only staff members who had undergone disclosure and barring checks and had provided suitable references were employed.

There were procedures to manage risks to individuals and the environment so that people were protected. These included risk assessments, business continuity plan and procedures in place to deal with foreseeable emergencies.

People were supported to eat and drink sufficient amounts. Where required people had access to healthcare professionals in order to improve their health.

There were procedures to ensure that consent was sought before care was delivered. Where people lacked capacity best interests decisions were sought. The staff and the manager were aware of the process to follow in order to lawfully deprive people of their liberty where necessary.

Staff received annual training and appraisal as well as regular supervision and monthly team meeting. Staff members were supported during the induction period and were encouraged to develop in their roles by taking on roles such dignity and dementia champions.

We observed that staff were caring and compassionate and responded quickly when people called. People’s privacy and dignity was respected.

Care plans reflected people’s individual preferences and were reviewed monthly or when people’s care needs changed.

People had access to various activities daily and their preferences were noted and considered. Relatives were involved in activities and told us they could visit at any time they chose.

We found that people relatives and staff were aware of the complaints procedure and would not hesitate to raise any concerns. Complaints were responded to in a timely manner and according to people’s satisfaction.

There was an “open, no blame” culture. Staff told us they had opportunities to feedback or discuss any issues with the manager and the deputy. The home’s values included encouraging “individuals to lead a purposeful life and enjoy independence, choice and total respect”. Staff were aware of these values. We saw evidence that the service was working towards accreditation for end of life care and for valuing staff development.

We last inspected Priory Residential Home on the 2nd July 2013 and found they were not meeting the required standard in relation to the safety and suitability of the premises. At this inspection we found the service had met this essential standard of care.

People spoke positively about the changes that had taken place and with the care they received. A relative we spoke with said “my wife is happy here, they do a lot for her and its lovely here. They make sure she eats. The improvements to the home seem continuous and I visit more or unless every day.” Another person said “a lot of changes have been taking place. We have had new chairs to make it nicer. I’m not just saying it but it’s really nice here, we have nothing to grumble about. I’m really quite happy.” A member of staff told us “it needed updating and it’s 100 times better for the residents. The new manager has bought in a lot of new changes.”

We found that people who used the service had access to premises that were suitably designed and adequately maintained. There were maintenance checks in place to ensure the proper operation of the building. This meant that people were protected against the risks associated with unsafe premises.

People spoke positively about the care provided at the service. A relative we spoke with said, 'we looked at a few homes and we picked this one. My mother is kept clean, is fed well and I get here as often as I can.' Another relative said, 'the care is fantastic here. It is the next best thing to home.'

People who used the service told us that they felt safe at the home and were well looked after. One person we spoke with said, 'I feel safe here and the staff are good to me.'

There was enough qualified, skilled and experienced staff to meet people's needs. People we spoke with said that, "staff are all very friendly and pleasant." A relative we spoke with said, "I am very happy with the care staff and they are all very welcoming."

We found that people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. People we spoke with told us that they always felt comfortable in raising concerns and knew they would be resolved. A relative said, "I would complain if I wasn't happy and I’m sure they would sort it out."

Although a refurbishment programme was in place. We found that the provider had not always taken steps to provide care in an environment that was adequately maintained.

People told us what it was like to live at the home and described how they were treated by staff and involved in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs were met.

The inspection team was led by a CQC inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective and a practising professional.

We 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. We observed that people who used the service were supported to eat and people enjoyed meal times.

People who use the service spoke positively about The Priory Residential Home. When asked what they thought about the care provided at the home, one person said, “I couldn’t ask for anything more, its home from home here.” Another person said, “I haven’t had any problems here.” People who use the service made positive comments regarding the meals provided at the home. One person said, “The food is very nice.” We found that people were protected from the risks of inadequate nutrition and dehydration.

People who use the service told us that they felt safe and well looked after. They had no concerns about staff attitudes and told us that staff were “caring." Although we received positive feedback regarding staff, there was not enough staff to meet people’s needs. Staff told us that they found it difficult to cope at times with current staffing levels.

Care plan documentation of people using the service lacked consistent and accurate information. People were not involved in their care planning and in the review process, which meant they did not have appropriate information provided to them about their care.