Palm Court Nursing Home

People's experience of using this service and what we found

Palm Court had a person-centred culture which ensured that staff in all roles were motivated and offered care and support that was compassionate and kind.

There was a good ethos within the service of treating people with dignity and respect. People were at the forefront of the service delivery and the provider was committed to providing a good quality service. We received generally positive feedback from people, staff and relatives. Any issues were already known by the service and were being addressed. For example, ensuring that individuals were receiving adequate engagement and leisure activities through improved recording and auditing. The feedback reflected staff were kind, caring and committed. A relative said, “The staff are as near to perfect as you can get. They bring [person’s name] doughnuts. I feel I can go home and know [person’s name is ok.” People complimented the continuity of care provided by regular staff, especially during the pandemic, which contributed to the building of meaningful relationships.

Care and support plans were reviewed and changed as people's needs changed. The service worked closely with healthcare professionals. People were supported to maintain good health and to meet their nutritional needs.

Staff told us they were supported by the management team. The manager and management team provided supportive leadership and had developed a dedicated staff team who were committed to the vision and values of the service.

The provider had effective quality assurance systems in place which were used to drive improvement.

People living at Palm Court who were able to communicate effectively told us they received safe care from skilled and knowledgeable staff. Staff knew how to identify and report any concerns.

The provider had safe recruitment and selection processes in place. Risks to people's safety and well-being were managed through a risk management process.

There were sufficient staff deployed to meet people's needs.

Medicines were managed safely, and people received their medicines as prescribed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Rating at last inspection

The last rating for this service was requires improvement (published 9 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 15 (Premises and equipment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well Led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Palm Court on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Palm Court Nursing Home (“Palm Court”) provides personal and nursing care for up to 36 people aged 65 and over. At the time of the inspection, 30 people were receiving care on day one and 31 on day two.

Palm Court accommodates people in one building over three floors. The third floor accommodates people mainly living with dementia.

People told us they were cared for by staff who were kind, compassionate and responsive to their needs. The feedback we received from people and relatives was very positive. They said they were involved in their care planning and, felt staff responded to them in a personalised manner.

However, we found the provider had not always acted on feedback to ensure people’s living environment was at a standard acceptable for people to live in.

People were cared for by enough staff who were caring and treated them with respect and dignity. Staff knew how to keep people safe from harm and from becoming unwell. Health needs were met, and health and social care professionals were involved as needed. Medicines were safely managed and how people’s care was planned was personalised.

We identified gaps in the recruitment process which was acted on after the inspection. The same with some issues with infection control and related care plan records.

We found the registered manager was keen to hear any ways they could improve the service during and following the inspection. Any feedback was immediately picked up and work started to further improve the service. Complaints and concerns were also responded to and fully investigated. Learning was taken from events such as falls and medicine areas and shared with staff to improve practice.

A professional told us, “If we consider Palm Court in terms of whether we would want our family placed there: Palm Court would be my first choice. Palm Court is well run, full of staff who are compassionate and interested in what they do, it exudes an atmosphere of warmth and fun and people appear to be genuinely well cared for.”

Rating at last inspection

The last rating for this service was Good. The report was published 12 May 2017.

Why we inspected This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the effective and well led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection was undertaken on 10 and 11 April 2017 and the first day was unannounced. This was the home’s first inspection since the home changed ownership in April 2016.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The people living at Palm Court had complex nursing needs or were living with advanced dementia. Not everyone we met and spoke with was able to share their experiences with us. Those who could told us they were cared for by very kind and caring staff. One person told us, “I’m very well cared for”, another said, "they’re lovely”. Relatives were complimentary about the staff and the way in which they met people's needs. One said, “They are absolutely amazing” and went on to say the staff were “very caring and friendly.” Another said the staff provided “compassionate care” and they had “a lovely way with people.” During the inspection we spent time observing the care provided in the home. We found staff worked well together and supported people in an unrushed, caring and compassionate manner. We saw staff instigated and encouraged conversation and spent time with people in the communal lounge and in their rooms.

People received effective care and support from well-trained staff who had been safely recruited. People and relatives told us the staff were knowledgeable about people’s care needs and were competent in their role. Regular training ensured staff had the skills and knowledge to care for people well and to be responsive to their changing needs. Staff had their performance monitored and reviewed through regular supervisions and an annual appraisal. There was a strong management structure within the home and all staff were aware of their responsibilities towards people’s wellbeing and safety. Suitable arrangements were in place for safeguarding people from abuse. Staff told us, and records showed, they had received training in safeguarding people. Staff told us what they would do if they suspected abuse and who they would report it to. They said poor practice would not be tolerated by the home and they were confident the registered manager would listen to any concerns they had.

People said they felt safe in the home. They were supported by sufficient numbers of staff on duty both during the day and overnight. Risks to people’s health, safety and well-being had been assessed and management plans were in place to help reduce the risks. The management plans gave staff clear guidance on how to support people to reduce these risks. People’s medicines were managed safely and people received these as prescribed.

Many of the people living at Palm Court did not have capacity to make choices about how they received care and support. In the Provider Information Return sent to use prior to the inspection, the registered manager said, “It is our philosophy that residents are supported to have as much freedom, choice and control over what they do as possible.” Each person’s care plan identified whether they could consent to their care. A document entitled, “Me and making decisions” described whether people had capacity to make decisions and when they might require support from others. We saw that when necessary best interest meetings had been held. Staff supported people to be as independent as possible. Care plans showed that people and their relatives had been involved in discussions about the type of support they wanted and required. Those people who were able to share with us their experiences of living in the home said they had no concerns about the care and support they received. One person said, “I’m very well cared for. I have no complaints, the staff are very good.” Relatives also told us they had confidence their relative’s care needs were being well met.

People told us they enjoyed the food provided by the home. One person said, “The food is very good and there is plenty to drink” and another said, “The food is very good. The staff always make what I would like.” Relatives told us they were invited to have a meal with their relative if they wished. Those people who required assistance to eat and drink were supported safely. People at risk from not eating or drinking enough to maintain their health had their needs routinely assessed, were closely monitored and support plans were developed with the guidance from the GP and community dietician.

People were referred to a variety of healthcare professionals when necessary, such as specialist nurses and physiotherapists. The GP held a surgery at the home once a week where they would review and discuss people’s health needs. The GP was present during the first day of our inspection and they told us they were confident with the home’s ability to meet people’s health care needs.

People, relatives and staff told us the home was well managed. The home had well organised management structure. All staff had specific roles and responsibilities when on duty. Quality assurance and governance processes were in use to help the registered manager to assess the safety and quality of the support provided. There were systems of weekly, monthly and annual quality assurance checks and audits. During our inspection we found the provider, registered manager and the staff team to be committed to providing a good quality caring service. The provider told us they wished the home to be “the nursing home of choice for people” and they and the staff team were working well together to achieve this. They recognised that if the home provided an excellent level of care and support for people, it would also be a home of choice for nurses and staff to work in. The provider told us they wished staff to feel they had a career path to follow and therefore staff were supported to develop their management and clinical skills. The home employed two consultants with expertise in general and mental health nursing. This ensured the registered manager and staff had up to date information about best practice in nursing care.