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 provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.
 

This service scored 62 (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 were at the centre of their care and treatment choices and they did not always work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

Some staff told us information was included in care records about how to support their needs. One said, “Staff are informed of changes in dietary requirements and care plans are updated. Staff can read care plans at any time on the system.”However, others raised concerns about their access to information that supported people’s personal care needs. They told us, “It’s all task-driven” and, “Staff are unaware of residents’ care plans, preferences, or risks. Care is driven by routines and management instructions rather than individual needs.”

There was information in the electronic care planning system about people, but this was not being reviewed appropriately and was not always accurate to ensure it reflected people’s individual needs.

Most people and relatives told us they were happy with the care provided in the service. Most said they had been included in changes and were informed of concerns about their family member. One said, “The staff always let me know if there's any changes or things that need to be changed in [person’s care plan].” Another relative talked about the improvements in their family member since they moved into the service.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity.

Relatives told us professionals were involved in people’s care when it was needed. Some told us about concerns where their family members package of care had been reduced by professionals and the potential impact this may have on them.

Staff and the management team told us that professionals were visiting the service regularly. We observed a number of professionals visiting the service during the assessment including both health and social care partners. Care records had information about assessments undertaken by professionals, but these had not always been reflected in their records.

The provider supplied some, accurate and up-to-date information in formats that were tailored to individual needs.

Relatives told us they were happy with the communication they received from the service.

Staff feedback about supporting people in communicating in a way that supported their individual needs was mixed. Some told us, “Communication is included in people’s care records”, “Reinforced (people’s needs) in handovers about communication to highlight residents (people) with increased safety risk” and, “Often this is difficult to ascertain when the residents (people) have dementia, reduced cognition or communication difficulties. Relatives are encouraged to visit and bring personal items for the residents’ rooms.” However, others said, “There’s no effort made, behaviours are seen as attention seeking” and, “Care plans and communication guidance are not available or explained, which increases the risk of unmet needs” and, “Staff are not adequately trained to recognise non-verbal communication or signs of pain.”

We saw some evidence about how to communicate with people in their care records and there were policies and training in place to support and guide staff about supporting people’s individual communication needs.

There was some evidence of the use of pictorial information including in the complaints policy, some signage on bathrooms and doors and used in staff surveys. However, bedroom doors were not adequately signed to support people to locate their rooms.

The provider made it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support.

We saw surveys had been completed in the last year and the outcome of these were on display in the entrance to the service with a summary of the findings. However, we saw copies of more recent completed surveys, none of which had any comments recorded and they were all typed up on the electronic system. We discussed with the provider the benefits of undertaking a new survey to ensure these were reflective of people’s views.

A range of team meetings had taken place recently with topics recorded. Daily flash meetings have recently been reintroduced. Staff told us that following our observations of the first flash meetings these have improved and were timelier. They also said that any concerns would be discussed at daily huddle meetings.

The provider discussed where people were supported with an advocate. An advocate is an independent professional or person who supports people with important decisions.

Positive feedback in the compliments file in cards received – it would be beneficial to date when these were received to demonstrate these were new. Only verbal complaints received. A complaints policy was in place.

We asked staff about how they dealt with complaints. They told us, “I would speak to the (registered) manager or the owner or suggest they (complainant) do”, “Any concerns from a relative would be listened to, reassurance given that problem will be addressed ASAP, documented and the manager informed if not already on duty” and, “There have been massive improvements based on concerns that have been raised previously.” However, others told us, “Staff are discouraged from raising concerns, and complaints are often hidden or altered rather than escalated appropriately” and, “They (complaints) are discouraged and quietly shut down.”

Complaints were discussed in team meetings. There was a complaints file, with a copy of the policy included. The registered manager told us no formal complaints had been received; however, we saw notes from concerns meetings with relatives of a person and how to support them. A relative fedback that they had raised a concern with the management team which was not acted on in a timely manner. The provider told us they would take immediate action to follow up the concerns with them. We saw evidence of positive feedback in compliments and thank you cards.

The provider made sure that people could access the care, support and treatment they needed when they needed it.

Relatives told us people were supported to access professionals as required. However, some discussed concerns about changes by professionals made in relation to their package of care needs. We saw a range of professionals visiting the service and undertaking reviews. However, not all of these reviews had taken place in a timely manner. One person who required a review by a health professional was not referred to the appropriate team until the following shift.

Some of the visiting professionals were complimentary about the service and the engagement with them. One said, “I come to the home regularly, for me it is nice and friendly. Staff really help and support I see the same faces, and they know what they are doing.”

Staff and leaders did not actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

Care records included information about people’s care and reviews were seen. However, these required improvement as they failed to reflect people’s current and individual needs, they had not been updated to reflect their need. There was evidence of hand over records, but these were not being done daily and staff told us handovers were not being held every day. Information in these did not always reflect people’s needs accurately.

Relatives told us they were included in discussions about their family member’s care. We spoke with staff about whether people were treated fairly and their choice and wishes supported. One told us, “Some people are treated worse than others.”

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.

Information in care records included their end of life wishes and how to support them safely. Records included information when DNACPR (Do not attempt cardio pulmonary resuscitation) were in place.

Some staff told us they had not received end of life training. One said, “Staff are expected to just cope.” We saw end of life care on the training matrix but not all staff names who were working in the service were included in the matrix. A policy was in place and up to date to support the staff team in supporting people’s end of life needs.