Palace House Care Home with Nursing

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• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

The service was in breach of legal regulation in relation to ensuring people received person centered, individualised care.

This service scored 65 (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 always treat people with kindness, empathy and compassion, or respect their privacy and dignity. Staff did not always treat colleagues from other organisations with kindness and respect.

We observed mostly kind and caring interactions taking place between staff and people. Staff were mostly undertaking care delivery with kindness, respect and maintaining privacy and dignity. However, we observed staff undertaking a personal care task with 1 person where the door to a communal bathroom was left open. This meant this person’s privacy and dignity was not maintained.

We asked staff about how they ensured people were treated with kindness and their privacy and dignity was maintained. One told us, “Care plans aim to consider personal preferences.” However, others raised concern that care was not person centred and was, “All task-driven”, and, “Person-centred care is not consistently delivered.”

There was policies, guidance and training in dignity and respect. However, not all of the staff team were able to confirm that they had received relevant training in this. One told us, “Staff have not received proper training in dignity and respect.” The training matrix did not confirm all of the staff names working in the servcie, so we were unable to confirm all staff had undertaken the relevant training available to them.

People and relatives were positive about the staff team and said they were treated with kindness and their dignity was respected. Comments included, “My [relative] has been here almost 6 years it's a lovely home and I know that [relative] is safe.” A professional told us about their experiences in the service. They said, “I am happy with the home what I have seen I would say if I had any concerns.”

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences.

People and most relatives were happy with the care they received. They told us, “Staff have gotten to know my [relative] well. I am confident they have the care [my relative] needs both day and night.” However, another relative discussed a concern about their family member’s care. We discussed this with the provider who assured us that the appropriate care had been provided to this person.

Staff we’re speaking kindly to people, and it was apparent staff knew the people living there and engaging in nice conversations and supporting them. We discussed with the management team the importance of ensuring all staff spoke in a language that all people in the service could understand what was being said regardless of the tasks they were undertaking. We discussed how staff communicated with 1 person in their preferred language.

Staff knew about people’s individual needs. They told us it was people’s choice where they liked to spend their day, whether this was in communal areas or in their bedrooms. We saw a number of people who spent the day in their bedrooms. Staff told us, “I now feel free to be able to spend more time with people.” However, 1 staff member told us they did not support people’s individual needs. They said, “Routines matter more than people.”

The provider promoted people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing.

Care records included information about people’s individual choice and needs. However, these were not always up to date. For example, we observed a number of people in their beds for very long periods in the same position. Staff told us they had undertaken positional changes but that they had moved themselves. However, when we checked their records it was not recorded that were able to move themselves and it was their choice. The provider told us they would ensure all of these people’s records were accurate and up to date. Up to date policies and guidance were available to support staff in ensuring people received care according to their individual needs.

The registered manager told us a staff member was supporting people in the service with activities whilst they recruited a permanent activity co-ordinator. Basic records had been recommenced recently that recorded the activities provided to people.

There was some evidence of activities taking place in the form of musicians visiting the service and some basic but nice reminiscence about the local area with some people in the lounge. People were seen enjoying the musicians in both the lounge and when they visited their bedrooms. We observed during the lunchtime period the television was showing a TV programme which did not appear to be appropriate for the people living in the service. The management team agreed and provided assurance they would ensure all people had access to programmes appropriate to people.

We asked staff about the activities. The staff member who was responsible for activities discussed what activities they provided to people and their plans to make improvements going forward. They told us they had undertaken ball games in the lounge, and a musician had visited that morning. Other staff said, “Yes, we do try to improve this (activities), people have 1 to 1’s, and I think they have an activities coordinator, but I am not sure” and, “Residents are encouraged to join in with communal activities or supported to access outdoor spaces and the community after being assessed for safety and risks. Visiting entertainers will see those who are bedbound in their rooms.” However, others told us, “People spend most of their time bored and isolated” and, “There are no meaningful or regular activities. Social stimulation is only provided when CQC (Care Quality Commission) or external professionals are expected. Residents who remain in their bedrooms receive little to no engagement, and community access is very limited.”

The provider listened to and understood people’s needs, views and wishes. Staff did not always responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

People and relatives told us they were supported with their needs and that they were always made to feel welcome. We observed staff responded well when nurse call bells went off to support them in their rooms. However, not all people had access to their call bell. We saw one person’s call bell was on the floor which meant they would be unable to ask for staff help if they required it in their bedroom. The management team told us they had been given this, but the person had moved it themselves. Another person was seen walking around without the use of shoes. We did not see that staff encouraged or supported with appropriate footwear. Staff told us this again was the persons choice.

On day 2 and 3 of the assessment we observed staff were a constant presence in the lounge to ensure people’s immediate needs could be acted on. However, this was not always the case on day 1 of the assessment and more staff were required when people were helped with drinks and meal times.

Staff told us that where people lay in bed most bedroom doors were left open as people preferred it and that they could hear or see people, so they didn't feel so isolated. However, we saw very little engagement with people other than those who required 1:1 support or mobilising in the corridors.

Some staff we spoke with knew about people’s needs and ensuring care was provided as they needed it. However, others told us, “Due to lack of communication, poor handovers, and no access to care plans, staff do not have a clear understanding of resident’s needs” and, “Staff ask residents what they like and dislike.”

The provider did not always care about and promote the wellbeing of their staff. They did not always support or enable staff to deliver person-centred care.

Some staff were positive about the management and senior team. Comments included, “I have never felt as well supported in my life as I am right now”, “So supportive (The provider) is in the home, and listens” and, “Owners are approachable and really accessible for staff team.” However, other staff told us they did not feel supported by the management team. They said, “Staff are disposable, staff feel blamed for everything”, “Staff do not feel safe or supported” and, “The (registered) manager doesn’t want to know and owner, they don’t care.” The provider told us they had recruited a new management team, and they were working hard in the service to support and engage with the staff team.

There was some evidence of team meetings taking place and some recent records completed by the provider stating all staff have had a 1 to1 meeting. However, the record does not record accurately that all staff had received a 1 to 1 meeting and no record of each individual 1 to1 meeting to confirm what was discussed or agreed. Some staff told us team meetings are taking place, but not all confirmed they were. Comments included, “Staff meetings are frequent especially after any incidents or issues” and, “They have team meetings monthly and flash meetings daily. The last monthly meeting was in December.” Others said, “No monthly meetings”, “Meetings are rare and pointless, and “Regular staff meetings do not take place, and feedback from staff is not encouraged or acted upon.”