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Palace House Care Home Requires improvement

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Requires improvement

Updated 27 November 2018

We carried out an inspection of Palace House Care Home on 30 and 31 October 2018. The first day was unannounced.

Palace House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as 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.

Palace House Care Home provides accommodation and care and support for up to 33 people. The service provides nursing care. There were 30 people living in the home at the time of the inspection.

Palace House Care Home is an extended detached older property which has retained many original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift. Car parking was available to the rear of the house.

At the time of our inspection, the registered manager was no longer managing the service. A new manager had been in post from August 2018 but had not yet applied to register with CQC. A registered manager is a person who has registered with 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 last inspection on 1 and 2 November 2017, our findings demonstrated there was a continued breach of the regulations in respect of staffing; the service was rated Requires Improvement. The service had also been rated Requires Improvement following the inspections of March 2016 and March 2017. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the service to at least good and to identify the date when this would be achieved.

During this inspection, we found improvements had been made. However, we found a breach of regulation 12 in relation to medicines management. Therefore, this is the fourth consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not always managed safely. The clinical commissioning group medicines optimisation team were supporting management and staff with making improvements. However, we found there were still some shortfalls in medicine management practices in the home and further improvements were needed. People received their medicines when they needed them and staff administering medicines had received training and supervision to do this safely.

Quality assurance and auditing processes were in place to help the manager to effectively identify and respond to matters needing attention. We saw evidence of regular monitoring that had identified shortfalls in the service and appropriate action had been taken to address the shortfalls. However, the audit tools had not identified the shortfalls found during the inspection in relation to medicines management. The manager addressed this following the inspection. People's opinions on the quality of care provided were sought. The provider had good oversight of the service.

We found people’s care records and staff members’ personal information were stored securely in locked cabinets and were only accessible to authorised staff. The manager could describe the improvements being made to systems and records in response to shortfalls found during the audits.

Risk assessments had been developed to minimise the potential risk of harm to people. They had been reviewed in line with people's changing needs. The manager was currently improving the incidents and accidents recording and monitoring systems.

Safeguarding adults' procedures were in place and staff had received training. Staff understood how to protect people from abuse and

Inspection areas

Safe

Requires improvement

Updated 27 November 2018

The service was not consistently safe.

Improvements were needed to ensure people's medicines were managed in accordance with safe procedures. Medicines were administered by trained and competent staff.

The deployment of staff had improved and sufficient numbers of staff were available to meet people's needs at all times.

People felt safe in the home and were protected against the risk of abuse.

Accident and incident monitoring and reporting and the management of risks was being undertaken to ensure people's safety. The manager was making further improvements in this area.

Effective

Good

Updated 27 November 2018

The service was effective.

Staff were provided with training, support and professional development. People felt that staff were competent and could support them effectively.

The environment was safe and comfortable for people to live in. There was a development plan to support planned improvements; a system of reporting required repairs and maintenance was in place.

People enjoyed the meals and their dietary needs and preferences were met. People were supported with their healthcare and were referred appropriately to community healthcare professionals.

People’s capacity to make safe decisions had been assessed although the manager was aware people’s consent to care needed further development. Authorisations to deprive people of their liberty had been submitted where required.

Caring

Good

Updated 27 November 2018

The service was caring.

Staff responded to people in a friendly, caring and considerate manner and we observed good relationships between people, management and staff. We observed some caring interactions from staff.

People were encouraged to maintain relationships with family and friends. There were no restrictions placed on visiting.

Staff respected people's rights to privacy, dignity and independence and were protected from discrimination. Where possible, people could make their own choices and were involved in decisions about their day.

Responsive

Good

Updated 27 November 2018

The service was responsive.

People had been provided with appropriate meaningful and interesting day time activities and stimulation both inside and outside the home.

People were not clear about the complaints process but felt confident raising their concerns and complaints with the manager or staff. Improvements were being made to ensure people were aware of how to raise their concerns and complaints.

Each person had a care plan which included details about their needs and preferences. Care plans and associated records had been kept under review.

People, or their relatives, had been involved in discussions about their care and some had been involved in the review of their care plan.

Well-led

Requires improvement

Updated 27 November 2018

The service was not always well led.

The manager was not registered, and had not forwarded an application to register with CQC. It is a condition of the provider's registration that there is a registered manager in post.

There were systems to assess and monitor the quality of the service. There was evidence that shortfalls had been identified and acted on. However, we found a breach of regulation with regards to medicine management.

People made positive comments about the manager and staff. They felt the service was well managed and they were happy with the recent changes and improvements made.

Records were managed safely and stored securely. Further improvements were being made in line with shortfalls found.