Palmarium

Updated 24 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by three inspectors and a medicines inspector.

Service and service type

Palmarium is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us.

Palmarium is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spent time observing care and support and informally interacting with all 3 people living at the service. We used an electronic communication system to speak with 1 person to hear their views of care provided. We spoke with 8 members of staff, a regional operations manager, a regional operations director and the provider’s commercial director. We also spoke with 5 visiting healthcare professionals.

We reviewed care and medication records for 3 people, recruitment files for 4 members of staff, health and safety records, quality monitoring records, policies and procedures, meeting minutes, incident and behaviour analysis, training data, staff survey results, health monitoring records and staffing rotas.

We spoke with a further 6 members of staff on the telephone and two relatives about care and support provided. We also received feedback from 1 relative and 2 healthcare professionals by email.

Updated 24 December 2022

About the service

Palmarium provides accommodation and personal care for up to 7 people with a learning disability and/or sensory impairment. Accommodation is provided on 2 floors accessed by stairs. People have their own self-contained flat and access to outdoor space. Six flats are within one adapted building and one flat is detached sited next to the main home. The location was within walking distance of local amenities such as shops and a park. At the time of our inspection there were 3 people living at the service.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s experience of using this service and what we found

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Where people lacked capacity to make their own decisions, evidence was not always available to demonstrate decisions had been made following the principles of the Mental Capacity Act 2005. Evidence to demonstrate best interest decision making was not available which meant the provider could not be assured least restrictive options had been implemented. This was a concern as restrictions on people’s liberty were in place.

People’s care and support was not outcome focused and the provider failed to support people to be independent and active in their community. Risks to people’s safety were not managed consistently and staff did not have opportunity for de-briefs following all incidents. This led to missed opportunities for avoiding reoccurrence.

Right Care:

People did not experience person-centred care. People’s care and support plans were not kept up to date with changes of needs and did not reflect individual’s wishes and aspirations. People had not been involved in planning their own care and were not encouraged to maintain their levels of skills. This had led to people losing some of their independence and abilities to be active partners in their care. Care and support provided did not consistently ensure people had a good quality of life.

Systems to make sure safeguarding processes were followed were not robust. Professionals investigating safeguarding concerns told us trying to gather information had been difficult. Not all safeguarding incidents had been reported to CQC as required by law.

People had their medicines managed safely. Whilst there had been some medicines incidents the provider recognised these shortfalls and had taken action to improve. Staff received medicines training and had their competence levels checked.

People had enough staff to support them. There had been a turnover of staff which had led to inconsistency in some people’s support, but the provider had experienced some recruitment success. The provider was aiming for people to have a core group of staff who worked with them consistently and knew people well. Overall staff enjoyed working with people and wanted to provide good care.

Right Culture:

Leadership and management had been inconsistent. Since the service opened there had been changes in management and a turnover of team leadership. This had led to poor communication and a concern from professionals, families and some staff about whether care and support was safe. The provider did not have a clear staffing structure in place at this service, this meant there was confusion about staff roles and responsibilities.

Provider systems had not been followed in some areas of care provision and staff told us they were often unsure about what they were doing day to day. Staff told us things changed regularly and because of poor communication they were not always updated.

Staff were aware of people’s needs and recognised the importance of activities to meet people’s sensory needs. However, this was not always demonstrated in practice. People needing visual references did not always have them available, one person did not have access to their sensory activity temporarily which was really important for their well-being. We could not see any effort made to provide them with alternatives. The service had not been supported by the provider to make sure best practice was implemented throughout the service.

Quality monitoring had not identified all the shortfalls found at this inspection and had not made sure providers systems and processes were being followed. The provider recognised this and had taken steps to start improvement work. Other managers had been asked to work at the service to carry out improvement needed.

We found the provider to be open and transparent about shortfalls seen. They recognised the service was not to their usual standard of operating. A new manager had been recruited and started their induction during our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 11 July 2022 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people’s care and support and safeguarding concerns. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to consent to care, safe care and treatment, lack of person-centred care and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.