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.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst improvements had been made to make sure people were at the centre of their care and treatment choices, there were still some areas that needed development. People’s needs in relation to how they spent their time were not always holistically assessed and responded to.

People’s care records did not always reflect if attending an activity would be of benefit to them or link to a group activity in which they had a particular interest in. Whilst some people were supported in the communal lounge during the day, there was a lack of regular opportunity for other people who remained in their room. One person said, “I do see staff, but I get bored, nothing to get my brain going.” Another person said, “Nothing really I do, watch a lot of telly, but I do have visitors.”

Daily records reflected peoples’ personal care but lacked any mention of peoples’ mental health or emotions. We observed staff do more with people than had been documented, but there were people who expressed their social needs, and these were not always met. This was an area that senior staff were working on with all staff.

Peoples’ oral health needs were not being consistently met, this was identified to the manager, who immediately introduced individual oral health care plans with guidance for staff and all staff are to receive specialist training in managing oral health.

It was not clear how staff offered people choices regarding personal care, the care documentation (daily notes) just stated personal care given, but not whether it was an assisted wash in bed or chair, a shower or bath. Some people would prefer a bath occasionally but had never been offered one.

There were some very detailed care plans regarding people’s individual physical health needs, these included diabetes, medicine, anxiety, and constipation.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

The home worked closely with a number of health professionals involved in people’s care. The manager was receptive to advice and feedback from other professionals and used this to improve care. A health professional said, “Communication has improved recently, they contact us for advice and guidance which is good.” Relatives told us, “They ensure my loved one sees a doctor when they need to, a chiropodist also visits, I am very happy with care.”

Care plans had been reviewed and now contained detailed information about people's health and medical needs. They also included evidence of regular partnership working with health professionals such as specialist nurses, and therapy teams. These records were well documented and showed responsive co-ordinated care. Staff were able to discuss how they ensured people were treated equally and fairly no matter their age, sexuality or their health diagnosis. They told us of their knowledge of the Equality Act and how they used this in supporting people and decision making.

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

There was a lack of dementia friendly signage and aids in the home. This had been identified at previous inspections and not yet progressed. Staff told us they thought people would benefit from some dementia friendly aids that would help them to understand information. For example, in finding their way around, to help them find their bedroom, or choosing their meals and activities and maybe seeing the food on a plate rather than on a menu would be helpful. There were no individual person centred tools to assist people in communicating their needs.

All care plans were on a computer, and this enabled them to be printed off for family, hospital appointments and transfers. They could also be enlarged for those that have sight impairment however there was no evidence that information had been provided in a pictorial format to enable people to share a concern or tell staff they were unhappy or in pain.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The standard applies to all people with a disability, impairment or sensory loss and in some circumstances to their carers. These were assessed and recorded within individual communication care plans. These included specific information on how people’s communication needs could be met and what aided their communication. For example, those who needed spectacles or hearing aids had specific care plans. Systems to support people to communicate with staff, relatives and friends had been assessed and promoted. For example, staff supported people to phone their loved ones as necessary. Staff spoke of pictorial aids for some people but we did not see them in use during our inspection. Staff however, had created a useful tool for a person whose first language was not English which enabled people to ask how they were.

Relatives told us that communication had improved as there was no agency staff being used and they were provided with information in a timely way. They spoke of a recent meeting held where they were encouraged to bring up any issues and discuss ideas regarding social events, staffing and other ‘home’ specific agenda points.
 

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

Feedback from visitors and people demonstrated that communication had improved but still needed further improvement to ensure everyone had a voice and was heard. One person told us, “I keep telling them I don’t want to have to go to lounge, it’s too busy, too loud.” Alternative quiet areas had not been utilised despite this feedback and so the person remained mostly in their room.

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 made sure that people could access the care, support and treatment they needed when they needed it.

Families and staff confirmed people were able to access care, treatment and support when they needed to. One visitor said, “No complaints at all, they act on my relative’s behalf and they recently did see a specialist nurse I think.”

There was evidence within peoples care records that when staff identified a health issue, they acted immediately, and people received treatment and care promptly. Staff said, “We ring the surgery for advice if we are worried, someone from the surgery visits weekly.” One staff member said about the environment, “There is pretty level access everywhere and lifts so everyone can go where they want to. The gardens are much more accessible now as well.”

One health professional told us, “Always polite, seem to be on top of people’s needs now.”

People’s care plans contained information about their wishes in relation to how their social, cultural and spiritual needs needed to be met. This included care plans around sexuality, emotional support and daily lifestyle.

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.

Improvement was seen within individual care of how people’s health and physical needs were tailored to them as individuals. However, the care documentation had not progressed to demonstrate how people who lived with dementia were supported to receive care in a way that they required, taking into consideration their sensory and emotional needs. 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, this still meant that some people spent a lot of time alone in their bedroom and they only saw staff when they were performing a scheduled task.

There were areas within the home that were not being used that would support and benefit people who lived with dementia, such as sensory rooms and quiet lounges. Dementia equipment was not in working order and this was going to be taken forward by the management team.

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.

Improvements had been made to documentation to ensure 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 still limited information recorded regarding their choices and preferences in the event of their death. It was confirmed that this was being discussed with people and next of kin as care plans were reviewed.