Palm Court Nursing Home

Updated 12 August 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by 3 inspectors. An Expert by Experience made calls to people’s relatives after the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Palm Court Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Palm Court Nursing Home is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We spoke with the local authority market support team and safeguarding team who had visited the service recently. We used all this information to plan our inspection.

During the inspection

We spent time with people that used the service and observed interactions between people and staff. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

We spoke with 5 people that used the service and 15 people’s relatives about their experience of care and support at the home.

We spoke with 15 members of staff. This included the nominated individual, registered manager, clinical lead, head of care, nursing staff, activity and maintenance staff, senior carers and carers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed records relating to 10 people’s care and multiple medicine records. We looked at documents relating to quality assurance. We looked at two staff files in relation to recruitment.

Updated 12 August 2023

About the service

Palm Court Nursing Home is a residential care home providing personal and nursing care up to 53 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 40 people using the service.

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

The service had recently implemented a new care planning and recording system which was not yet embedded into staff practice. Improvements were needed to reporting processes to ensure that accidents and incidents were correctly identified and investigated appropriately. People's care plans and risk assessments needed work to ensure they contained accurate information on how to support people safely.

People's daily records did not accurately reflect the care and support they were receiving or events that happened throughout the day. Recording was inconsistent, incomplete and there was a risk that information needed to keep people safe was being missed.

People were not always provided with person-centred care. Activities provided for people were not sufficient to keep people engaged. Staff did not always respond to people appropriately when people were upset. Guidance for how staff should support people if they became anxious or distressed was not clear. People and their representatives had not been given the opportunity to contribute to care planning and relatives wanted to be able to attend meetings at the home with other relatives.

There were enough staff to support people safely and staff knew people well. Improvements had been made to infection prevention and control processes as well as the environment. People were being admitted to the service safely. Some improvements had been made to governance and oversight.

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 requires improvement (published 2 February 2023) and there were breaches of regulation. CQC served a Warning Notice to the provider following this inspection relating to concerns around safe care and treatment, person centred care and governance.

At this inspection we found that although improvements had been made in some areas, the provider remained in breach of regulations.

Why we inspected

We undertook this comprehensive inspection to check whether the Warning Notice we previously served in relation to Regulations 9, 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement

We have identified breaches in relation to safe care and treatment, person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.