Palace House Care Home with Nursing

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to ensuring care records were detailed and supported people’s needs, the effective management of people’s nutrition and hydration, and protecting people from unlawful restrictions.

This service scored 46 (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 make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

Assessments and reviews of people’s needs were being developed in an electronic care planning system. There was some evidence of detail in these however, information was very contradictory, confusing and sometimes incorrect.For example, 1 person’s care record and dependency record did not include information about escalating and disruptive behaviours and another person’s record did not confirm daily care tasks were provided; in line with the care plan. Daily monitoring charts were not always being completed in full or reflected the accounts in hand written accident and incident records. Daily records were being completed about the days event for people.

We asked staff about the involvement of people or families in the development and reviews of people’s care records; we received a mixed response. They told us, “Trained nurses complete care plans and reviews. Staff are informed of changes in dietary requirements and care plans are updated. Staff can read care plans at any time on the system” and, “Staff have handovers at change of shift and can read it (handover records) on the system anytime.” However, others said, “No one who actually delivers the care (is involved in care plan development and reviews)” and, “No one knows how to create a care plan.”

Most relatives fedback that they were happy with the communication they received and felt included in any changes or concerns around their relative. Comments included, “The staff always let me know if there's any changes or things that need to be changed in [my relative’s] care plan” and, “I am confident [my relative] has the care they need.”

The provider did not plan and deliver people’s care and treatment with them. They did not follow legislation and current evidence-based good practice and standards.

We observed the mealtime experience. People were observed to be distressed due to being sat for very long periods waiting for their lunch, we asked the management team to provide sufficient staff to support people with their lunch as it was clear insufficient staff were in place to support them. The provider told us the dealy was due to unplanned pressures on the staff in the service.The lunchtime experience was much improved on day 3 of our visit however, we observed used dishes left for long periods in people’s bedrooms after meals, and 1 person was noted to be eating independently in bed despite their care record reporting a risk and required supervision. Other records including information about people’s assessed needs and risks associated with meals and fluids were noted to be either incorrect, out of date and at times missing, in particular records available to the kitchen staff. This meant people would be at risk of choking if they received a diet that did not follow their assessed needs. The provider took immediate action to review all of the people in the service in relation to their nutritional needs to ensure this reflected their current need. They told us how they planned to address the shortfalls in food and nutrition.

A 4-week menu plan was in place; however, this was not always being followed. Most people were provided with meals according to their choices however, we saw 1 person’s preference in relation to their breakfast was consistently not being provided. This was despite a clear directive from the senior management team to ensure their choice of food was provided to them. Some people had meals according to their religious requirements. People were being offered a Halal option however, it was clear there was little variety in the meals provided to them. The provider gave assurances they would take action to ensure people were offered a varied choice of food.

People told us they were enjoying the food they were provided, and most relatives raised no concerns about the meals provided to people. They told us, “It was lovely” and, “It's taken a while, but my [relative] is eating more now.” We saw meals looked appetising and fresh.

We checked the kitchen and saw supplies of food available for people, however staff fedback that they had recently changed where they ordered supplies from, and they did not always get the food they required for the menus due to a lack of clarity when orders would be delivered.

Temperature and cleaning checks were in place. However, these were not always being completed in full in particular at the weekend when the usual kitchen staff was off duty. Staff told us, this had been raised with the registered manager. One said, “It has been a lot of work but there are improvements since the owners have been coming into the home (service).” Whilst the kitchen was tidy, we observed a number of staff; including the management team entering the kitchen without using the appropriate PPE.

The provider did not always work well across teams and services to support people.

The registered manager discussed the involvement of professionals in people’s care. There was evidence of correspondence with health partners however, this information was not always being included in the electronic care planning system to ensure staff had access to all of the information about people’s needs. We saw in 1 persons care records that a medical review had been required however, this was not acted on by the staff member in charge of the shift, and a review of this person was only commenced by staff on the next shift. The provider took immediate action to investigate our concerns about the delay in accessing a review for this person.

Relatives told us they were informed of changes in people and if they required a hospital admission they would be informed. One said, “The home (service) always includes me in any changes such as medication or visits to the hospital.”

The provider did not always support people to manage their health and wellbeing. Staff did not always support people to live healthier lives.

Staff told us they did not always receive a handover record at the start of each shift. They commented, “Information shared verbally during handover is completely different from what is documented” and, “I was not made aware of (a concern) it was not shared at handover and there was no handover record provided.” However, others told us, “Staff have handovers at change of shift and can read it on the system anytime.” We saw handover records were being produced on the electronic care planning system and on handwritten records. Whilst the information in the record was beneficial to the staff team it was not always accurate in its content.

Care records were in place, but they did not always have accurate information about the outcomes of assessments by professionals. The provider gave assurance that they would develop an action plan to ensure our findings were acted on.

We asked staff and the management team about the involvement of professionals. The registered manager and provider discussed the recent challenges in relation to securing 1:1 funding to ensure appropriate staff were in place where this was required.Staff told us, and we saw professionals visiting the service during our assessment to undertake reviews of people to ensure they had the appropriate package of care to meet their needs.

A health professional told us they visited the service regularly and that it was sometimes difficult to understand what support or assessment was required for people they are reviewing. However, another professional talked to us about their positive relationship with the service and the staff team.

The provider did not always effectively monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent.

There was some evidence that behaviour monitoring charts were being done which recorded where people were displaying distressed behaviours. However, not all of the records we checked included information about what action staff had taken as a result of the behaviours, any outcome or debrief after the incident.

Some care records did not confirm what action the service had taken to ensure people were reviewed by relevant health partners in the event of an incident.

A range of information and guidance was on display in communal areas and, policy and procedures were up to date and contained information to support and guide staff.

There was evidence of supporting peoples oral care needs and involving professionals when required. Staff training and policies were available to support people’s oral care needs.

The provider did not always support people with their rights around consent, but they respected their rights when delivering care and treatment.

The DoLS (Deprivation of liberty safeguards) information in the electronic care planning system had not been updated where there had been changes in people’s care and the support they required. Some of the care records included information about consent for people however, we saw one of these had been signed by the registered manager on the persons and the relative’s behalf.

The registered manager told us that staff received DoLS training, this was confirmed by the training matrix. However, not all staff names on the duty rota were recorded in the training matrix. An up to date policy was available to ensure staff had access to information to ensure unlawful restrictions were not taking place.

We observed staff knocking on doors and asking permission before undertaking any activity. We asked staff about the importance of consent and DoLS. The feedback was mixed. They told us, “Consent isn’t really considered” and, "I have had DoLS and Mental Capacity Act training.” Another said, they had, “No idea (Whether people had DoLS).”