Palace House Care Home with Nursing

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of regulation in relation to people’s safe care and treatment.

Risks assessments were not always robust and didn’t always contain enough detail to guide staff on how to safely care for someone. The environment people lived in was not always safe as we found storerooms unlocked which contained hazardous chemicals and infection prevention and control measures were not always robust.

Medicines were not always stored and administered safely, and we found records to be lacking in detail. Concerns were raised about staffing levels and not everyone felt there was enough nursing staff employed to ensure people’s medicines were managed well.

Accidents and incidents were recorded and analysed and a lessons learnt process was in place. People were supported to move between services safely and staff had good knowledge of safeguarding procedures. Staff were recruited safely and supervisions were being carried out.

This service scored 59 (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 had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. People and their relative’s felt people were safe using this service and that any accidents or incidents would be managed well. Relatives praised the service for keeping their loved ones safe. One relative said, “They (Person using the service) have had no (incidents) since being here and they have not been unwell either which is amazing.”

Staff were knowledgeable on what to do should someone have a fall and felt confident in the management of incidents. Accidents and incidents were recorded and a detailed analysis completed. This analysis looked at trends and themes which could help reduce future incidents occurring, as well as a lessons learnt process which was shared amongst the staff team. Some bedrooms had been fitted with a sensor which monitored people’s movements and alerted staff should a fall occur. This aided in minimising future risks.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Staff told us they were informed of new admissions to the service and were given information on how people wanted to be cared for. One staff member said, “The (registered) manager gives us a rough idea of what people are like so we have a snapshot of how to care for people. The nurse will then upload a care plan (onto the electronic system).” The registered manager explained the process of how people were safely transferred to hospital. This involved ensuring the person had the relevant paperwork including medication lists, care plans and next of kin details. This information was also shared when people were moving to another care setting.

Partners felt referrals to their services were made in a timely manner. One partner said, “(Nursing staff) contacted for support with a resident (person who used the service), (I) observed organised methodical thinking and staff acting in the best interests of the resident.”

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. People and their relatives felt safe at Palace House Care Home with Nursing and comfortable around the staff team. One relative said of their loved one’s care, “I feel they are safe in here, there is someone here 24-7.” Staff were knowledgeable on what to do should abuse be suspected. One staff member said, “I would inform the (registered) manager if I thought someone was being abused. I have had training on how to spot signs of abuse.”

Staff were observed to be supporting people in a caring and supportive manner with patience. Systems were in place for investigating concerns and a robust lessons learnt process was in place as well as a policy which helped guide staff should abuse be suspected.

DoLS (Deprivation of Liberty Safeguards) paperwork was up to date and relevant to people’s current circumstances. However, not all staff knew what this meant in practice. Following the assessment, the registered manager arranged training for all staff in this area.

The service did not always work well with people to understand and manage risks. They did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were not always robust. Nutritional risk assessments were not always accurate which included the management of thickened fluids. This could have caused a choking risk should the incorrect amount be given. Mobility risk assessments did not always include specific details. For example, for those who needed to be mobilised using a hoist and sling, the risk assessment did not guide staff on what size sling to use or what loops this needed to be on to ensure the person was mobilised safely. Behaviour charts were not always completed and when they were, they were not detailed enough to evidence what action had been taken when someone was suffering from periods of distress and what the outcome was for the person. Following on from the assessment, the registered manager ensured all risk assessments were accurate and robust and arranged training for staff in relation to the completion of behavioural charts.

Detailed plans were in place which took into consideration people’s specific healthcare needs and guided staff on what to do should a person’s health condition deteriorate. People and their relative’s felt risks were managed well. One relative said, “[Person using the service] can’t use the buzzer in their room but the carers check on them regularly and take them to the lounge during the day.” Staff told us they were confident in managing distressed behaviours and explained how they would de-escalate situations. One staff member said, “If someone is distressed, we give them space, we can’t force them to engage with us. We fill out incident charts.”

We observed staff managing risks well and although people were at times suffering from periods of distress, staff were on hand to guide people and divert them to another activity. On one occasion staff took a person outside for a walk to help keep them occupied.

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. The environment had been adapted to suit people’s needs and the communal areas were being decorated during the assessment process; however, there were some aspects of the service which were not safe. A room containing hazardous chemicals was unlocked and wardrobes in some bedrooms were not secured to the walls which could pose the risk of them falling. A storeroom was unlocked which contained various items such as an air freshener and medicated creams and fire concerns were still apparent, despite the fire service recently visiting and giving recommendations. Water temperature was being tested; however, no action was taken when the temperature was too high. The registered manager rectified this during the assessment process and ensured all storerooms were locked and water temperatures were rectified as well as securing all wardrobes to walls. The fire concerns were in the process of being rectified which included PEEPS (Personal Emergency Evacuation Plans) which were not always accurate.

We saw evidence of good practice including fire alarm and emergency light checks, bed checks, lifting equipment servicing and wheelchair checks. Some of these checks were carried out by the on-site maintenance team.

Relatives told us the environment people lived in was safe and well maintained and praised the ongoing improvements that were being made to the service. One relative said, “It may not be the most modern building, but the care is amazing.” Staff also told us the environment was safe and they that they knew the fire procedure. One staff member said, “It is absolutely safe here. We have had fire training, and we all meet at the assembly point (should a fire occur).”

The service did not always make sure there were enough qualified, skilled and experienced staff, however, they worked together well to provide safe care that met people’s individual needs. Some staff felt there was not enough staff, in particular in the mornings and during medicine rounds. We observed there to only be one nurse on duty on both days of the site visit. The nurse was responsible for ensuring handover information was passed on, dealing with incidents and healthcare professionals and administering medicines. The provider took this feedback on board and was in the process of recruiting more nursing staff to assist during busy periods. We did notice some gaps in staff training; however, this was rectified during the assessment process and face to face training had been arranged.

Other staff were complimentary of the staffing levels and the training provided. They said, “There are plenty of staff here. There are agency staff as well, but we all get the same training. There are lots of different training courses. For example, we just did a face-to-face course on managing seizures. This was really helpful and interactive.” We did observe plentiful numbers of care staff in communal areas during our site visit and for those people who required 1-1 care, there always appeared to be a staff member with them. Staff were observed to be kind and patient with people, and we witnessed staff treat people with compassion and humour throughout their interactions.

There were safe systems of staff recruitment in place. All required employment checks had been undertaken prior to staff commencing employment which included interview notes and staff induction. Supervisions were being carried out as well as staff appraisals.

People and their relatives spoke highly of the staff team and felt there was enough staff to safely care for people. One person said, “There always seems to be enough staff around. I have a buzzer in my room if I need to call for anyone. They come quite quickly if I need them.” Relatives told us staff were trained well. One relative said, “We cannot fault the staff they are well trained in what they do.”

The service assessed and managed the risk of infection. However, we did find some concerns in this area. Although the service appeared to be clean and tidy, we did find there to be unpleasant smells on both days of the site visit which prompted the inspector to alert the registered manager of this on a number of occasions. Clean and unclean laundry was stored near to each other, and we found bags of soiled laundry in communal bathrooms. The cleaning schedule was not always completed at the weekend. These concerns were rectified during the assessment process.

People and their relatives felt the service was clean and tidy. One person said, “It’s always clean here and no horrendous smells.” Staff told us the service was clean, and they had adequate supplies of PPE (Personal Protective Equipment). They said, “The home is clean and tidy and looked after.”

There were plentiful supplies of PPE as well as guidance around the service on good hand hygiene techniques. The kitchen appeared to be clean and tidy and we saw evidence of audits being completed. Guidance was available should an outbreak occur. The directors advised of an on-going improvement plan which included concerns that needed to be addressed, the outcome and target date for this to be achieved.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning. The service had medicines trained nurses to administer medicines and trained care staff applied all topical applications. Due to the size and complexity of the service, some morning medicines were late being administered. We raised this with the registered manager and action was taken. We looked at medicines administration records and observed medicines being administered. We found that some administration was not immediately recorded in line with national guidance. There was a risk that medicines could be administered twice if records were not completed straight away. Records did not always demonstrate the need for medicines administered for agitation. Some people were prescribed medicines to be given when required, however we could not match behaviour to administration records or see any record of distraction techniques used to reduce agitation.

Creams were not always applied as prescribed. Records showed some medicated creams were applied too often or not enough as staff did not follow the instructions on the label or record. There is a risk of harm if topical medicines are not applied properly. Managers monitored the management of medicines with a number of audits both internal and from the local authority. However, the issues found during the inspection had not been previously noted. We also found that creams were not always stored safely or at the correct temperature.