Palace House Care Home with Nursing

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 service met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people’s needs were met through good organisation and delivery.

People’s cultural preferences were taken into consideration and the service worked well with healthcare professionals to ensure there was joined up continuity of care. Documents were available in various formats to support people’s communication needs and surveys were given out to people to ensure their feedback was heard.

Contingency plans were in place for emergencies and people’s advanced wishes had been considered. We did however find that not all daily records were person-centred, and confidential paperwork was not always secure.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service made sure people were at the centre of their care and treatment choices and they decided, in partnership with people, how to respond to any relevant changes in people’s needs. People told us staff knew them well including their likes and dislikes. People felt their cultural preferences were taken into consideration. Staff understood the meaning of person-centred care. They said, “We tailor people’s care to meet their needs. Some people have personalised bedrooms like football themes because this is their choice.” All bedrooms had the person’s name on the door with a picture that meant something to them for example a picture of themselves or a loved one. This meant their bedroom would be easily identifiable to them. Bedrooms were personalised and included sentimental items, pictures and themed rooms. One person had curtains and pictures with their preferred football team on. Daily notes were not always person-centred and at times were generic. The registered manager rectified this during the assessment process.

The service understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. People and their relatives told us there was continuity of care. One relative said, “The staff seem to have been here for a long while. There is not much turnover of staff leaving and new staff starting and they know the residents well and the residents know them too.” Staff told us most of the staff team had worked at this service for a while and knew people well. If staff wanted to know more about a person, they would look at their care plan. The registered manager ensured care was joined up by following healthcare professional plans. For example, if the dietician advised a person should be weighed weekly, this would be documented and communicated to all staff. Partners did however feel care could be rushed at times. One partner said, “The nursing staff have a lot on and are giving out important medicines. I feel more nursing staff would make it easier for them as they are rushed off their feet.” The directors responded to this during the assessment process and were in the process of recruiting more nursing staff to assist at busy periods.

The service supplied appropriate, accurate and up-to-date information in formats that were tailored to individual needs. However, we did find confidential paperwork in communal areas that was not secure. Concerns were also raised about staff’s ability to communicate. One relative said, “The staff here are very good at communication but the majority, their first language is not English and sometimes it’s a bit difficult to understand their accent.” Despite this, everyone we spoke to said staff would inform them of any incidents or healthcare professional referrals.

The registered manager had knowledge of the Accessible Information Standards and advised that various documents including the service user guide would be available in large print should this be required. The registered manager explained how they ensured communication was effective. This included picture cards and writing important information down for those who were hard of hearing. Staff had training on communication and record keeping and detailed communication care plans were in place.

The service made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. They involved people in decisions about their care and told them what had changed as a result. People knew how to raise concerns should they need to. One person said, “If I had any concerns, I would be happy to say but I don’t have any.” Not all relatives were aware of relative meetings; however, these were completed annually and not everyone had attended one yet. We did see evidence of the last resident and relative meeting and completed surveys. Staff told us if people or their relatives raised any concerns, they would escalate this to the nurse or the registered manager. We reviewed the complaints folder and found not all complaints had been responded to in detail. The registered manager advised all complaints were taken seriously and that once a complaint was resolved, this was shared amongst the staff team for future learning.

The service made sure people could access the care, support and treatment they needed when they needed it. Relatives told us they were happy with the care their loved one received. One relative said, “The home is very good. It’s a lot better than we feared when we first put [person using the service] in here. They need 1-1 care and they have been great.” People told us care was tailored to their individual needs and there was always staff around to help should they require any support. Staff spoke highly of the service and how it had been adapted to meet people’s individual needs including the secure garden space. Staff also told us how they ensured people who stay in their bedrooms were cared for. One staff member said, “We avoid social isolation by doing 1-1 activities in bedrooms, colouring and word searches. We assist people to do them, and they feel like they have achieved something.” We observed a singer entering people’s bedrooms who were unable to attend communal areas. This ensured people who were in their bedrooms did not miss out on entertainment and helped to prevent social isolation.

The registered manager told us on call arrangements were in place and that there was always someone from the management team on hand to support staff out of hours. Contingency plans were in place and there appeared to be sufficient numbers of staff to meet people’s needs should an emergency situation occur. Care plans held a record of people’s reasonable adjustments and guided staff on how best to support people.

Staff and leaders actively listened to information about people who were most likely to experience inequality in experience or outcomes and tailored their care, support and treatment in response to this. People and their relatives told us this was an inclusive service and that staff treated people fairly. Staff told us they treated people fairly by ensuring people were comfortable and at ease. Staff knew how to support people who had concerns and supported people to express their views. Policies were in place to support equality and diversity and care plans held a record of people’s physical needs which guided staff on how best to support them.

People were 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. The registered manager told us any advanced wishes were taken into consideration, and advice was sought from the frailty nurse should this be required. Plans were in place as required for people’s advanced wishes. Policies were in place in this area, however, there were gaps in staff training. The registered manager was in the process of arranging training for all staff in this area.