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Inspection Summary


Overall summary & rating

Good

Updated 12 October 2016

This inspection took place on 17 August 2016 and was unannounced.

Palmyra is a Making Space residential care home which provides accommodation and personal care for 14 people with mental health needs. The home is situated in a residential area of Waterloo, Merseyside which has easy access to local amenities and transport links. The service is provided over four floors with lift access available.

During the inspection, there were 14 people living in the home, including one person who had been admitted to hospital.

A registered manager was 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 we spoke with told us they felt safe living in Palmyra and we observed people to be relaxed and comfortable within the home. Staff we spoke with demonstrated a good understanding of safeguarding procedures and were able to tell us how they would report any concerns. Safe recruitment practices were also followed to ensure staff were suitable to work with vulnerable people.

We looked at how medicines were managed within the home and found there were processes in place to ensure safe storage and checking the stock balance of medicines. Not all handwritten directions on the MAR charts were checked by two people and photographs were not always available to ensure all staff could identify people and we made a recommendation regarding this.

We looked at how the home was staffed and found that there were sufficient numbers of staff on duty to meet people’s individual needs.

Incidents were reported appropriately using the provider’s electronic system. There were systems in place to assess risks to people and the environment to ensure measures could be put in place to minimise risks and help ensure people’s safety. Regular fire drills were completed and recorded. The last drill reflected that response was poor and the registered manager took steps to help improve this.

The registered manager told us that no people living in Palmyra required a DoLS to be in place and was aware of when a person may require an application to be made and how to undertake this.

Staff we spoke with told us they always asked for people’s consent before providing care and we observed this during the visit and within care files. When there were concerns that people may be unable to provide consent, the Mental Capacity Act was followed.

New staff completed an induction in line with the requirements of the care certificate and staff were supported through regular supervisions, an annual appraisal and on-going training.

Feedback regarding meals available was positive. The menu offered choices and advised that alternatives were always available. Staff we spoke with were aware of people’s dietary needs and preferences.

People told us staff were kind and caring. We observed people sitting with staff in the dining room throughout the day, listening to music, drawing and chatting and people were relaxed and comfortable. We observed people’s dignity and privacy being respected by staff.

All care plans we viewed showed that people had been involved in the completion of relevant risk assessments and the creation of their care plans and had agreed to the care in place.

Care files included information on people’s preferences, what was important to people, what people admired about the person and how best to support them to ensure their needs were met. They had been reviewed regularly and it was evident that people were involved in these reviews.

The registered manager told us they had an open door policy and that there were no restrictions in visiting, encouraging relationships to be maintained.

We found that staff knew people well and we observed staff responding to people’s needs in a timely way throughout the day.

There were relevant activities available for people to participate in and people were encouraged and supported to maintain leisure interests. Regular day trips were arranged to places people had expressed interest in visiting.

Processes were in place to gather feedback from people, including quality assurance surveys and regular meetings. There was a complaints policy and complaint forms available within the home.

We asked about how the home was managed and feedback from staff was positive.

Staff we spoke with were aware of the home’s whistle blowing policy and told us they would always raise any issue they had.

Staff also told us they were encouraged to share their views regarding the service and that their ideas were considered and implemented if possible. Staff told us there was good communication between all staff and that they worked as an effective team.

Records showed that the provider visited to review the service regularly throughout the year. Actions required to further improve the service were identified and those we followed up had been addressed.

We also observed completed audits which covered areas such as medicines management, first aid, staff recruitment and health and safety. This meant that systems were in place to monitor the quality and safety of the service.

CQC had been notified of events and incidents that had previously occurred in the home in accordance with our statutory notifications.

Inspection areas

Safe

Requires improvement

Updated 12 October 2016

The service was not always safe.

Not all safer medicine management practices were followed.

People we spoke with told us they felt safe living in Palmyra.

Staff we spoke with demonstrated a good understanding of safeguarding procedures and safe recruitment practices were followed.

There were sufficient numbers of staff on duty to meet people’s individual needs.

There were systems in place to assess risks to people and the environment to ensure measures could be put in place to minimise risks and help ensure people’s safety.

Effective

Good

Updated 12 October 2016

The service was effective.

Nobody living in Palmyra required a DoLS to be in place but the registered manager was aware of when a person may require an application to be made and how to undertake this.

Consent was gained in line with the principles of the MCA.

Staff were supported through induction, regular supervisions, an annual appraisal and on-going training.

People were supported by the staff and external health care professionals to maintain their health and wellbeing.

Feedback regarding meals available was positive and staff were aware of people’s dietary needs.

Caring

Good

Updated 12 October 2016

The service was caring.

People told us staff were kind and caring and we observed warm interactions throughout the day. We observed people’s dignity and privacy being respected by staff.

Care plans showed that people had been involved in the completion of relevant risk assessments and the creation of their care plans.

Care files included information on people’s preferences and we found that staff knew people well.

There was an open door policy and there were no restrictions in visiting.

Responsive

Good

Updated 12 October 2016

The service was responsive.

Care plans were specific to individuals and had been reviewed regularly.

Staff told us they were informed of any changes within the home, including changes in people’s needs.

We observed staff responding to people’s needs in a timely way throughout the day.

There were relevant activities available for people to participate in.

Process were in place to gather feedback from people.

Well-led

Good

Updated 12 October 2016

The service was well-led.

Feedback regarding the management of the home was positive.

Staff were aware of the home’s whistle blowing policy and told us they were encouraged to share their views regarding the service.

Staff told us there was good communication within the home and that they worked as an effective team.

Systems were in place to monitor the quality and safety of the service.

CQC had been notified of events and incidents that had previously occurred in the home in accordance with statutory regulations.