Palm Court Nursing Home

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained Requires improvement: This meant people’s needs were not always met.

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

This service scored 46 (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 were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Care was not person centred, care plans did not support staff to be able to safely or effectively meet people’s needs. Some people’s care documentation was out of date, with pertinent information missing, including people’s individual needs. There was a high use of agency staff and some new staff who did not have supporting documentation to inform them of people’s needs. For example, people’s mobility needs and risks had changed, people’s care plans and risk assessments had not been updated. We saw that staff were not aware how to support people safely when they tried to stand or mobilise.

When other health professionals had been involved in people’s care, guidance had not been added to care plans. This meant specialist advice was not being utilised to support people’s care and to keep them safe. For example, nutritional care plans and risk assessments had not been updated to include SALT guidance. Staff were unaware of this guidance as it had been filed in the nurse’s office and not updated in the person’s documentation.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

A relative told us, “They are very good with [relatives name] so I am very happy.” However, we found that communication and involvement with people’s relatives was not well documented. One relative told us, “They seem to be sometimes behind in telling us things but on the whole I have no worries.” There was limited information recorded which demonstrated how the provider worked with others to ensure joined up care for people.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Staff told us menu cards were available to assist people to make meal choices. However, we did not see these being used to assist people with dementia during the inspection. There was a lack of dementia friendly signage to assist people around the building.

There was limited evidence of people or relatives being involved in planning their care or care plan reviews.

The provider did not make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not involve people in decisions about their care or tell them what had changed as a result.

Feedback from people demonstrated that communication needed to be improved. We saw minutes for previous relative’s and staff meetings. There was no evidence queries, or concerns raised were responded to and addressed.

There was limited documentation to evidence that people, and their relatives if appropriate, were asked for their views and there were no clear actions taken in response to feedback.
 

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

We found people with bruising and wounds were not receiving appropriate skin integrity care. Unexplained bruising and injuries were not being identified or investigated. Documentation did not evidence that referrals to other health professionals had taken place in a timely manner. For example, we found bruising and skin tears which had required further treatment which had not been referred to the local authority as they had not been appropriately documented in care records. Accident and incident forms had not been completed, therefore, the acting manager was unaware of the injury. We also identified one incident which had not been referred to CQC, we discussed this with the acting manager, this has now been sent following the inspection.

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this.

Care documentation did not demonstrate how people who were not able to share their views or actively participate in their care decisions were supported to receive care in a way they required. For example, for people living with dementia it was not clear how the provider ensured people’s sensory and emotional needs were considered and met.Activity staff supported people to participate in activities. We were told a schedule was in place, but this was flexible. We saw people doing crafts, jigsaws and reading with activity staff. Activity staff spent time with people in the communal lounges and told us they tried to visit people who stayed in their rooms when they could. However, for some people this meant they spent a lot of time alone in their bedroom and they only saw staff when they were performing a task, for example during personal care or at mealtimes.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

People who were receiving palliative or end of life care, had documentation in their care plans regarding whether or not they had Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms. This is a document that outlines a person's preferences for emergency care, particularly in situations where they may be unable to communicate their wishes. However, there was limited information recorded regarding their choices and preferences in the event of their death. For people who were unable to share their wishes end of life care plans stated for staff to discuss plans with next of kin, however, there was no recorded conversation to demonstrate this had taken place.