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Palmer Crescent Requires improvement

We are carrying out a review of quality at Palmer Crescent. We will publish a report when our review is complete. Find out more about our inspection reports.

Inspection Summary


Overall summary & rating

Requires improvement

Updated 30 June 2018

Palmer Crescent is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Palmer Crescent accommodates up to 24 people in four bungalows on one site, each of which has separate adapted facilities. The registered provider of the service is Welmede Housing Association Limited, part of the Avenues Group, which specialises in providing care to people with learning disabilities or autism.

There was no registered manager in place at the time of our inspection. The previous registered manager had left their post at the beginning of February 2018. A new manager had been appointed and was due to take up their post the week after our inspection. 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. The provider’s cluster manager told us the new manager would apply for registration with CQC.

We found there was an over-reliance on agency staff which affected people’s experience of care. There was a high number of vacancies on the permanent staff across the four bungalows. The provider had maintained the staffing levels needed to keep people safe but the high use of agency staff meant people were often supported by staff who did not know them well. Relatives told us that it was important for their family members’ well-being to be supported by familiar staff who knew their needs well. They said the high use of agency staff was discomfiting for their family members. The high number of vacancies also placed pressure on the remaining permanent staff. They were working hard to ensure people received the care they needed but some staff were working excessive hours.

Shortages of permanent staff also affected people’s opportunities to take part in activities. There were not enough authorised drivers employed to take people to some of their planned activities and staff had to prioritise taking people to medical appointments. This meant that some people’s identified needs were not being met.

Following our inspection the provider’s regional manager acted promptly to develop an action plan to address the concerns we had identified. This plan set out how the consistency of care people received would be improved and how permanent staff would be supported. Actions included allocating experienced staff from elsewhere in the organisation to support the service until new permanent staff could be recruited and block-booking agency staff to ensure that regular agency staff were employed.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. Health and safety and fire safety checks were carried out regularly to ensure the home was safe and well maintained. The provider had developed a contingency plan to ensure that people’s care would continue in the event of an emergency. The bungalows were suitably adapted and designed to meet people’s needs. Adaptations and equipment had been installed where necessary to ensure people were able to mobilise safely.

Staff were recruited safely. The provider obtained evidence from agencies that the temporary staff supplied had undergone appropriate pre-employment checks. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had. People received their medicines safely and as prescribed. Staff maintained appropriate standards of hygiene and cleanliness and followed safe infection control procedures.

People’s needs had been assessed before they move

Inspection areas

Safe

Requires improvement

Updated 30 June 2018

The service was not consistently safe.

There were not enough staff with appropriate knowledge and skills deployed to meet people’s needs.

People were supported to take manageable risks as safely as possible.

Staff understood their roles in keeping people safe.

People would continue to receive care in the event of an emergency.

People were protected by the provider’s recruitment procedures.

Medicines were managed safely.

People were protected from the risk of infection.

Effective

Good

Updated 30 June 2018

The service was effective.

People’s needs had been assessed before they moved into the home to ensure their needs could be met.

Staff had access to the support, supervision and training they needed to support people effectively.

People’s care was provided in line with the Mental Capacity Act 2005 (MCA).

People were encouraged to maintain a healthy diet and staff were aware of people’s individual dietary needs.

People’s healthcare needs were monitored and they were supported to obtain treatment when they needed it.

The physical environment of the home met people’s needs and equipment and adaptations were in place where necessary.

Caring

Requires improvement

Updated 30 June 2018

The service was not consistently caring.

People’s experience of care was affected by a lack of consistency in staffing.

Staff treated people with respect and maintained their privacy and dignity.

Staff respected people’s choices about their care and support

People were supported to maintain relationships with their friends and families.

Staff supported people in a way that promoted their independence.

Responsive

Requires improvement

Updated 30 June 2018

The service was not consistently responsive to people’s needs.

People did not have enough opportunities to take part in activities.

Care plans had been developed where needs had been identified through the assessment process.

There were appropriate procedures for managing and responding to complaints.

The provider had established people’s preferences about their end of life care.

Well-led

Requires improvement

Updated 30 June 2018

The service was not consistently well-led.

The provider had not mitigated the risks to people and staff until these were highlighted in feedback following the inspection.

Relatives told us the provider communicated openly with them.

Staff were able to give their views at team meetings and said the previous registered manager was supportive.

The provider sought the views of all stakeholders through annual surveys.

Staff worked well in partnership with other agencies to ensure people received the care and support they needed

The provider’s quality monitoring systems ensured key aspects of the service were regularly audited.