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Palm Court Nursing Home Requires improvement

We are carrying out a review of quality at Palm Court Nursing Home. 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 22 June 2019

Palm Court Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Palm Court Nursing Home provides accommodation for up to 53 people in one extended and adapted building. Nursing care is provided to people who have nursing needs; most people were living with dementia. There were 25 people living at the service when we inspected. Since our last inspection the provider had agreed with the local authority that there would be no new admissions to the service until the health and safety arrangements were addressed.

At inspections carried out in September 2016 and June 2017 the home was rated Inadequate and placed and remained in special measures as there were continued breaches of Regulations. CQC took enforcement action in accordance with its procedures. We met with the provider and asked the provider to complete an action plan to show what they would do to meet the requirements of the Regulations. We received the provider's action plan and we followed up on breaches at an inspection in November 2017. At that time improvements had been made and although there was still a breach of Regulation 17, the home was rated Requires Improvement overall.

Our last inspection was carried out on 19 and 24 July 2018 and we rated the service Inadequate. The home was placed into special measures again. This was because we found breaches of Regulation 12 in relation to safety and Regulation 17 in relation to good governance.

We carried out this inspection on 13 and 14 February 2019 and found that although improvements had been made in many areas, there were still areas in relation to the management of medicines and to governance that had not sufficiently improved and were continuing breaches of Regulations 12 and 17. We also found that there was a lack of stimulation and meaningful activities for people and we made a recommendation to improve this area.

The registered manager had left their position in June 2018. 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. A new manager had been appointed and started in post on 2 July 2018. At the time of our inspection their application for registration was being processed and the manager has since become registered.

Concerns with the management of medicines mainly centred on the management of medicines prescribed on an as required (PRN) basis for the management of agitation as it was not always possible to see why medicines had been given. Linked with this was a lack of documentation in relation to records that demonstrated actions taken by staff to support people with behaviours that challenged before resorting to medicines. We found that whilst auditing had improved in many areas these had not identified areas we found on inspection, for example in relation to the management of medicines and shortfalls in recruitment records. Further time is needed to build on the progress made and to fully embed new systems into every day processes. Improvements were also needed to ensure people were offered regular opportunities for person centred activities.

Significant progress had been made in relation to the management of health and safety. All equipment was now serviced and inspected regularly and the records demonstrated that when faults were noted they were addressed in a timely manner.

Care plans provided detailed advice and guidance about how people’s needs should be met and we saw that staff were kind and caring and supported people in a way that suited their needs. One person told us, “Yes the staff are very kind

Inspection areas

Safe

Requires improvement

Updated 22 June 2019

The service was not consistently safe.

The management of medicines prescribed on an as required basis for agitation were not effective.

There were enough staff to meet people's needs safely.

Significant improvements had been made the health and safety arrangements within the home. There were risk assessments in place and staff had a good understanding of the risks associated with the people they supported.

Effective

Good

Updated 22 June 2019

The service was effective.

There were good opportunities to ensure staff had opportunities to develop their skills and knowledge through regular training.

The manager and staff had a good understanding of mental Capacity assessments (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were supported to maintain their health and wellbeing and referrals were made to health and social care professionals when needed.

People received enough to eat and drink daily.

Caring

Good

Updated 22 June 2019

The service was caring.

Staff respected people’s privacy and dignity and offered assistance in a kind and caring way.

Staff talked to people in a way they could understand.

Relatives and friends were made to feel very welcome and people could have visitors at any time.

Responsive

Requires improvement

Updated 22 June 2019

The service is not consistently responsive.

There were not enough person-centred activities provided.

The complaints procedure was available to people and their relatives to use if they wished. Complaints were managed effectively.

Care plans provided detailed information about how people’s needs should be met.

Well-led

Requires improvement

Updated 22 June 2019

The service was not consistently well led.

Although systems for auditing the service had improved, in some areas these were not accurate and further time was needed to fully embed progress made to be effective.

Feedback about the service provided was now sought from people, relatives and staff.

Staff meetings had taken place to inform of any changes and encourage staff to put forward suggestions for improvement.