Palmerston House Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question Good. At this assessment the rating has changed to Requires Improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

We identified a breach of the legal regulations. Poor governance arrangements meant employment checks/processes not always robust and there was a lack of sufficient oversight and quality audits of the service.

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.

The provider did not have a clear shared vision, strategy and culture which was based on transparency, equity, equality and human rights, and engagement. They did not always understand the challenges and the needs of people and their communities. For example, despite this being a service that specialises in dementia there was a distinct lack of dementia friendly items such as soft toys, tactile items, puzzles etc to aid people’s wellbeing. In addition, there was no dining area present in the service to aid social interaction to decrease the risk of isolation.

There were activities planned however they were not regular or varied enough to cater to people’s different needs and preferences. There was no accessible activity planner on display to aid people’s choice and inclusion. There was limited evidence of 1-1 sessions for people who had higher or multiple needs, for example, being cared for in bed, this meant there was not an equitable experience for everyone throughout the service.

The provider had inclusive leaders within the service who understand the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They did so with integrity, openness and honesty.

We found that the registered manager was well regarded by family and people we received feedback from. They told us, “The manager was in here yesterday – she is on the ball,” in discussing a complaint against a staff member another person told us, “I complained to the manager who had a word [to staff member] been fine since.” However, it was highlighted to the inspection team that things are not always dealt with in a timely manner, a family member told us, “Any concerns I can speak to the manager, she listens but they do not always remember, and I have to remind them and then it gets done.”

We found that when issues did arise family were kept informed and there was good information sharing between the provider and people at the service. One family member told us “It is very safe, they are quite good on communication”

During our assessment staff gave positive feedback on leaders within the service, a staff member told us, “I feel supported by the manager and seniors,” they also shared “Culture is not bad, got different languages, it is a happy group.” Another staff member told us, “I am very happy that I came here, the manager has trained me,” they later added “They are a really good manager – I am very very happy comfortable here.”

The provider fostered a positive culture where staff felt they could speak up and their voice would be heard. The provider had a freedom to speak up policy to support staff. Staff told us that they were aware of freedom to speak up and felt confident to speak up. One staff member told us, “We can make suggestions, if we can think of a better way to do something, they are happy to look into this and at times try.” Another member of staff said, “I feel listened too.”

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them.

The provider had robust and detailed equality, diversity and inclusion policies and procedures as well as reflecting this in their recruitment. A staff member who was complimentary of the manager told us about support they had received, “Supervision I did this earlier this year the manager said that I needed to improve my communication – this [English] is not my first language, and it has improved and now I listen good and take time and answer.”

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes.

The provider had a range of quality monitoring procedures in place including audits of various aspects of the service. However, audits and governance procedures were not effective and had not identified the issues we found during the assessment.

Governance systems did not ensure that care matched people’s assessed needs or that records accurately reflected their experiences. The systems and processes in place failed to ensure records were always accurate, complete or contemporaneous. We found examples where people’s care records were incomplete, insufficiently detailed, did not accurately reflect people’s experiences and did not contain sufficient information for staff to manage people’s specific needs or conditions. Risk assessments had not always been completed for known risks and mitigation plans were not always in place as per their assessed need.

As outlined in other areas of the report, the provider failed to have robust and effective systems in place to oversee medicines management and safe administration at the service. The provider also failed to have robust and effective systems in place to ensure safe recruitment practices in line with schedule 3 of the health and social care act. This meant we were not assured the registered manager and provider had effective oversight of the service to monitor and drive improvements to provide positive outcomes for people.

The provider did not always understand their duty to collaborate and work in partnership to ensure services worked seamlessly for people. They did not consistently work in a joined‑up way with partners to improve outcomes. We found that planned actions had not always been completed, which meant care and treatment outcomes were not always delivered on time. One person told us, “Recently I got a text from the doctor to say I needed an appointment for a scan. I spoke to the manager a fortnight ago and chased this up this week and I’m still waiting.” This shows that referrals and follow-up were not always managed well.

While statutory information sharing, such as safeguarding referrals and notifications to CQC, was generally effective, wider collaboration and follow-up were inconsistent. This lack of consistency meant people did not always access healthcare or community support in a timely way, which could lead to avoidable harm.

Although staff and leaders understood the importance of sharing statutory information, there was limited evidence that the service actively engaged with local forums, community groups or initiatives to share learning and improve care. Policies and meeting records did not demonstrate a strong focus on collaboration or continuous improvement. There was also little evidence of supporting people to integrate into the wider community, such as attending local dementia cafés or social groups.

The provider did not always focus on continuous learning and improvement across the organisation and local system. They did not always actively contribute to safe, effective practice and research.

The provider did not have an effective system or plan in place to monitor and improve the quality and safety of the service. Monitoring systems were not effective and had not identified the issues we found during the assessment as detailed in the various sections of this report.

The provider was willing to innovate, the provider informed us they were in the process of transferring to a digital system for various files that were currently paper based. The provider had changed to various systems over the past few years such as digital care planning and electronic medication administration systems amongst others that showed a willingness to innovate. However, we found the new systems were not utilised fully and staff knowledge on how to use them was lacking.