Palm Court Nursing Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This key question was not rated at the last inspection but had a previous rating of good. At this assessment the rating has changed to Inadequate. This meant there were widespread and significant shortfalls in people’s care, support and outcomes.

The service was in breach of legal regulation in relation to person centred care.
 

This service scored 33 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not make sure people’s care and treatment was effective because they did not check and discuss people’s health, care, wellbeing and communication needs with them.

People’s needs had not been regularly assessed and updated to ensure information was relevant and accurate. Care plans and risk assessments did not reflect people’s current needs, this put people at risk of inappropriate unsafe care.

Referrals to other healthcare professionals had not been documented clearly and documentation received that included recommendations had not being updated promptly in people’s care plans.
People’s care plans and risk assessments were not up to date and did not support staff to provide person centred care based on people’s current assessed needs. We saw examples where care did not demonstrate a person-centred approach. One person was moved from the lounge and put into bed. We asked staff why this person had been moved and received conflicting responses. One staff member told us the person was unwell, and another told us the person was expecting a visit from the chiropodist. We were able to establish that the chiropodist was not due until the following day. The RN confirmed the person was not unwell but had been taken to their room for personal care. It was unclear why they had not been brought back to the lounge.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Nutritional needs were not well documented to ensure risks were recorded and people’s choices and nutritional needs were updated. One person who was underweight did not have information in their care plan to remind staff to ensure fortified meals were provided. People’s likes and dislikes were not always followed. One person told us they were asked what they wanted for lunch that day and they had chosen. However, when their lunch was brought to their room it was not what they had requested, staff had apologised but it was not replaced. An RN told us that they had recently spoken to another person who was reluctant to eat their breakfast. The person had told them they did not like porridge made with water but were given this for breakfast. The RN had spoken to kitchen staff and reminded them of this person’s choices.

People’s weights were recorded but there was no oversight to identify concerns, for example, if a person was continuing to lose weight. Referrals to other health professionals including SALT were not clearly recorded in care plans.

Moving and handling guidance was not followed. We saw staff move a person using inappropriate moving and handling practices in the communal lounge area. This was also witnessed by RN’s and staff were spoken to regarding this on the day.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

Relatives told us, “Staff seem good but change a lot, not sure who is who, and no name badges, brought it up at last meeting, overall, I am happy, carers and nurses very good to [relatives name].”
Staff told us they tried to work together as a team. However, staff turnover and high use of agency staff made this very difficult. Staff also felt that staffing levels were not appropriate to meet people’s needs. We saw this in practice when people became distressed or needed support at mealtimes.

 

The provider did not support people to manage their health and wellbeing, so people could not maximise their independence, choice and control. Staff did not support people to live healthier lives, or where possible, reduce their future needs for care and support.

People’s choices were not always listened to and valued. We saw limited information recorded about people’s likes, dislikes and preferences or to demonstrate how people were supported to maintain their independence and mobility. One person was in a chair in the lounge throughout the day. This person was seen to attempt to get up. Staff responded by guiding them to sit down again. Care documentation included that this person liked to mobilise at times and walk with staff support. However, when we discussed this with staff they were reluctant to support this person to stand as they told us they were at high risk of falls. This person was assisted to stand and walk later in the day; however, staff did not appear confident on how to support them safely.

The provider did not routinely monitor people’s care and treatment to continuously improve it. They did not ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

Documentation relating to people’s needs had not been regularly reviewed and updated. Care documentation did not reflect people’s current care and support needs. Risk assessments did not identify current risks to people. This put them at risk of receiving inappropriate care. Records relating to accidents, incidents and falls were not robustly recorded. This meant that opportunities to identify improvements to people’s care and lessons learned taken forward had been missed. Care plans and risk assessments had not been updated to ensure people’s care was adapted and improved.
 

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Staff asked people for their consent before providing care. Mental capacity assessments had been completed. However, not all decisions made had supporting documentation. Conversations with family and next of kin were not always clearly recorded. For example, one person’s care plan said they were required to wear hearing aids. We saw this person did not have hearing aids in place during the inspection. After talking to staff, it was established that this person was not wearing hearing aids due to an identified risk. However, this had not been recorded in the care plan or risk assessment. An entry was seen on a care review which referenced a conversation with the persons family where they had agreed hearing aids will not be worn.