We carried out a review of the data available to us about Palmersdene on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Palmersdene, you can give feedback on this service.
Palmersdene is a care home providing accommodation and personal care for up to 40 people including people living with a dementia. At the time of inspection, 39 people were living at the home.
People's experience of using this service and what we found
Risks to people's health and well-being had been assessed and monitored to ensure they were kept safe. The provider had safeguarding systems and processes in place to keep people safe.
People felt safe and spoke positively of the staff and of living at the home. Staff understood what they needed to do to keep people safe.
The environment was clean and staff observed and followed infection control procedures in line with national guidance for reducing the spread of COVID-19.
People received support from staff who were recruited safely and received regular supervision to monitor their performance. Staff attended an induction programme and received ongoing training to support them to carry out their roles effectively.
People received their medicines when they needed them, and medicines were managed safely by suitably trained staff.
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.
Managers and staff had positive working relationships with external agencies and healthcare professionals ensuring that people's needs were met in a timely manner.
Staff spoke positively about working for the provider. They felt well supported and they could talk to the management team at any time, feeling confident any concerns would be acted on promptly.
Effective monitoring systems were in place and these helped develop the service and drive change and improvements.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 21 January 2020)
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.
We found the following examples of good practice:
• Appropriate measures were in place at the entrance and in the home to reduce the risk of infection.
• Personal protective equipment (PPE) was appropriately worn and disposed of.
• Social distancing rules were being complied with. Some minor changes had been made to the layout of furniture to encourage and support social distancing.
• The provider was following national guidance for anyone moving into the home and admissions were carried out safely.
• People were supported to keep in touch with their family members via video or telephone calls. The provider was developing ways to safely support visits in line with the latest guidance.
• The provider and registered manager ensured staff received appropriate guidance and support. Staff had undertaken additional training in infection prevention and control and regular audits were carried out.
• Staffing levels had been maintained during the recent outbreak with the support of agency staff.
Further information is in the detailed findings below.
Palmersdene is a care home providing accommodation and personal care for up to 40 people including people living with a dementia. At the time of inspection, 35 people were living at the home.
People’s experience of using this service and what we found
People told us they liked living at the home and they felt safe living there. The majority of feedback from relatives was very positive regarding the level of care and support provided. A visiting professional was also complimentary about the home. .
Appropriate environmental and personal risk assessments were in place to keep people safe. Medicines were handled safely by staff who had received appropriate training in this area. Staff were recruited safely.
People’s needs were fully assessed prior to coming to live in the home. This ensured the home could cater for people’s needs and ensured staff had the right level of skills and experience to care for people safely. Staff told us they received lots of training to support them in their role.
People were supported to maintain a varied, healthy and balanced diet. Feedback from people and relatives was complimentary about the variety and standard of food offered. People could choose what they wanted to eat from the menu or could ask for an alternative if they wished. People told us they had access to refreshments and snacks throughout the day. Where necessary, people were referred to healthcare professionals to support their health and well-being.
Most people and their relatives were very complimentary about staff and told us staff supported them in a very caring and dignified way. We did receive some less positive feedback and we shared this with the registered manager. Staff encouraged people to maintain their independence as much as possible and this was seen throughout the inspection.
People had access to a variety of activities both inside and outside the home and could access the garden area as they chose. People’s end of life wishes had been captured in their care plans.
The registered manager gathered feedback through various sources. They sent out yearly questionnaires to gather people’s and relatives’ opinions. This feedback was used to further improve the level of care provided. The registered manager carried out a range of monthly quality checks across all aspects of care and service provided.
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.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection (and update)
The last rating for this service was good (published 31 May 2017).
Why we inspected
This was a planned inspection based on the previous rating.
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.
At the last inspection on 4 and 5 February 2015, the service was rated good. At this inspection we found the service remained good.
Staff had completed training in safeguarding vulnerable adults and understood their responsibilities to report any concerns. Thorough recruitment and selection procedures ensured suitable staff were employed. Risk assessments relating to people's individual care needs and the environment were reviewed regularly.
Staff received appropriate training and support. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to have enough to eat and drink and attend appointments with healthcare professionals.
There was a welcoming and homely atmosphere at the service. People were at ease with staff and people and relatives said staff were caring. Staff treated people with kindness and compassion.
Staff had a clear understanding of people's needs and how they liked to be supported. People's independence was encouraged without unnecessary risks to their safety. Support plans were well written and specific to people's individual needs.
Relatives and staff felt the service was well managed. Staff described the registered manager as approachable and said there was an open culture. There was an effective quality assurance system in place to ensure the quality of the service and drive improvement.
Further information is in the detailed findings below.
This inspection took place on 4 and 5 February 2015 and was an unannounced inspection. The last inspection took place on 4 December 2013. At that time the service was meeting the regulations we inspected.
Palmersdene provides care for older people for up to 40 people. Nursing care is not provided.
At the time of this inspection there were 39 people living in the service. The home had a registered manager. 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 home is split over two floors, with the upstairs area being mostly for people living with a more advanced dementia or higher support needs.
The service was warm, (and whilst some modernisation of electrics, doors and windows had just begun), was clean and well maintained. There were eight care staff on duty and ten other staff. The service had an ethos of personalised support. This was demonstrated through the use of one page profiles outside some bedroom doors. The bedrooms were also called “flats” by staff, as the service ethos was this was their own flat, with its own front door.
Staff were always visible throughout the building, including upstairs where people living with more advanced dementia and needed extra support. We saw activities taking place throughout the day. Staff supported people to take part in these activities. When staff engaged with people these were all positive. For example, we observed one person started to cry at the table during lunch. A senior carer went to her and soothed her. Another person living in the service commented that staff appeared at times to be very busy, “They are a bit short staffed then they get stressed.” But over the two days staff were not seen to be rushed in any of their interactions with people.
The service had recently made changes to the breakfast routine in the downstairs dining area following consultation with the people using the service. For example, having set breakfast times to make it feel less chaotic and more relaxed. The registered manager advised us the routine around mealtimes upstairs was under review. This was following staff and one person living in the service attending specialist dementia training. The registered manager aimed to integrate the learning from this specialist training over time.
Staff and people we spoke with all said they felt safe. They told us they could report concerns about safeguarding, complaints or other issues. One person said, “Oh yes I feel very safe.” A relative said, “She was in sheltered housing before, she looks a lot better since being in here.” There was documentary evidence that complaints and comments were responded to. One relative had commented negatively that, “The only reason I knew about her hospital appointments was because my wife told me.” Another relative commented, “They always telephone me and keep me up to date with her care and appointments.” Evidence was seen of communication between the service and families, and their involvement where possible.
The home, gardens and bedrooms were all maintained to a high standard. The sluice room on the first floor needed tiles replacing and had continence pads stored where they could be at risk of contamination by waste. The service manager took immediate action to replace the tiles and order new sluice equipment. The service’s windows and internal doors were about to be replaced. Presently all windows had window locks and were in good order.
CQC monitors the operation of Deprivation of Liberty Safeguards (DoLS). There were a nineteen people in the home who were subject to the Deprivation of Liberty Safeguards (DoLS) process. Referrals had been made appropriately by the service and this was documented in people’s care plans. There was evidence of best interests decisions being made for people who lacked capacity under the Mental Capacity Act 2005; however we discussed with the manager that records needed to reflect the principles of the MCA.
Staff we spoke with all said they enjoyed their work. They demonstrated a positive ethos and understanding of the needs of individuals in line with their care plans. When safeguarding and whistleblowing were discussed, staff stated they would raise issues with the registered manager, and felt that she was approachable. One staff member stated, “If I saw ill treatment from (either) a resident or staff I would report it immediately.” We saw evidence in staff files of checking of references and Disclosure and Barring Service (DBS). Action was being taken with staff whose performance was not as the provider expected. Records showed regular staff meetings were held and that actions identified were then completed.
It was observed that medication was managed flexibly to ensure that those with time specific medications were prioritised.
The deputy manager had recently won a national care award. The service had its own award scheme. People living in the service, staff and visitors had the opportunity to nominate staff for an award.
During our visit, all interactions we observed between the staff and the people living at the home were open, respectful and courteous. We saw that people's needs were met in a calm and unhurried way. There were enough qualified, skilled and experienced staff to meet people's needs. Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.
The provider had an effective system to regularly assess and monitor the quality of service that people received. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service.
Some people were not able to tell us directly what they thought about the service. However, during our visit we spent time observing how care staff supported people and this was positive and respectful.
Care plans were written in a clear and easy to understand way and people's personal preferences were clearly recorded. There were sufficient staff on duty to support people for their care needs.
We looked at how the service recruited staff by checking five staff files. These showed that the appropriate checks and procedures were being followed.
Comments from people who live at Palmersdene included "The staff are always there if you need them.", "I do like it here. I keep myself to myself.", "The food is canny and so are the staff."
We spoke to three visitors of people who live at Palmersdene who felt that their relatives received good care and were looked after well. One told us "My x is happy here and she has put on weight since coming to live here" Another relative told us "I am happy with the staff here. They let me know about anything and I do not have any worries about this place."
We spoke with a number of people who live here, as well as visitors, staff and the registered manager. There were 35 people living in the home at the time of our visit but one person was in hospital.
Not all people using the service could comment about their care due to their disabilities, but some could.
We spoke with one person who was having a mid morning bacon sandwich, which they had requested. They commented very loudly that 'it's good here' but also said, 'it's really disappointing. I want to go to bed at half past eight but they make me wait an hour'. They said they had 'complained loads of times but no-one listens'. They commented that the food 'was beautiful'. They were also loudly critical of a care worker within that person's hearing. With their permission, their comments were discussed with the registered manager who felt sure that no person would have to wait an hour for assistance to go to bed.
We also asked other people how long they had to wait for assistance when they wanted to get up or go to bed. One person said they needed help from the care workers to get dressed but they did not have to wait longer than 15 minutes and felt this was acceptable. They said, 'I like it here, the carers are good'. They told us that they were able to live the lifestyle they wanted, and although aware that social activities took place, preferred to spend time in their own room. They told us they were treated well and had no concerns, but if they did, they would take these up with the manager.
Another person was very cheerful and told us they had lived here for ten years and liked it. They enjoyed 'keeping (themselves) occupied' with various hobbies.
We spoke to three visitors of people who live here who felt that their relatives received good care and were looked after well. Two told us they were always consulted and kept fully involved in their relative's care. They all felt the home provided good care, good nutrition and a good range of social activities. They all said that they would readily raise any concerns with the manager if they had any.