This inspection took place on 28 April and 2015 and was unannounced.
During a previous inspection of Primrose House in November 2013 we found that the home not meeting the requirements of the law in relation to management of medicines. We carried out a follow up inspection in March 2014 and found that the service was meeting the regulation and there were no concerns.
Primrose House is a nursing home situated in Harrow and is registered to provide care with nursing to up to 24 older people. At the time of our inspection there were 22 people living at the home, the majority of whom had dementia.
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.
People who lived at the home told us that they felt safe, and this was confirmed by family members whom we spoke with.
People were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring that people were safe and that concerns were reported appropriately.
Medicines at the home were well managed. People’s medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.
Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home. People who remained in their rooms for some or part of the day were regularly checked on.
Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking. All staff members received regular supervision form a manager, and those whom we spoke with told us that they felt well supported.
The home was generally meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. The majority of staff had received training undertaken training in MCA and DoLS, and those we spoke with were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions. However the risk assessments for people regarding use of bedrails did not show that this was the least restrictive option available to meet their needs which is a requirement of the MCA.
People’s nutritional needs were well met. Meals were nutritionally balanced and met individual health and cultural requirements as outlined in people’s care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day. People’s food and liquid intake was recorded and monitored. Health professionals were involved where there were concerns about nutritional needs.
Care plans and risk assessments were person centred and provided guidance for staff, but it was not always easy to access information that was linked within the care documentation. The registered manager was showed us a new, more accessible care planning tool that they would be introducing as care plans were reviewed and updated.
The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively in participation in activities. People’s cultural and religious needs were supported by the home and this was confirmed by a family member.
People and their family members that we spoke with knew how to complain. There was a picture-assisted version of the home’s complaints procedure, and this was discussed with at the regular monthly service user’s meeting.
Care documentation showed that people’s health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.
There were systems in place to review and monitor the quality of the service, and we saw that action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date and staff members were required to sign that they had read and understood any new or amended ones.
People who used the service, their relatives and staff members spoke positively about the management of the home.
We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.