Palm Court is situated in the seaside town of Dawlish, Devon. The home is situated near to the town and local amenities. Personal care, with nursing care, is provided for up to 36 older people.
A registered manager was employed by the service. 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.
This inspection took place on 17 and 20 March 2015. The service was last inspected on 3 April 2014 when we found several regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 had been breached. Regulation 17 (2)(c) was breached as people and/or their representatives did not always have opportunities to express their views and be involved in decisions about their care, treatment and support. Regulation 15 (1)(a) had been breached as improvements were needed to the environment. Regulation 17 (1)(a) had been breached as people’s privacy and dignity was not always respected. Regulation 10 (1) had been breached as there was not an effective quality assurance system in place. The registered provider wrote to us and told us they would have made the improvements to the environment by early 2015 and the other improvements by November 2014. At this inspection in March 2015 we found that some improvements had been made, but further improvements were still needed.
There were not always sufficient numbers of staff on duty to ensure people’s needs were met and keep them safe. No staff were available in the main lounge for over 15 minutes in the afternoon of one of our visits. People were calling out asking to be taken to their rooms or to the toilet. There was no call bell system available in this area and staff said people depended on staff monitoring the area in order to ensure people’s needs were met. During the morning there appeared to be sufficient staff to meet people’s personal care needs. There was always at least one member of staff in the main lounge during the morning.
People’s nutritional needs were not appropriately monitored to ensure they had enough to eat and drink. Several people required their nutritional and fluid intake to be monitored each day. Records indicated some people had not had enough to eat or drink. These people were at risk of becoming dehydrated and malnourished and the only way to check they had enough to eat and drink was through records. We observed lunchtime for ten people in the ground floor dining room. They had a good choice of food, all cooked on the premises.
Not all risks to people’s safety had been assessed and managed appropriately. There were no covers fitted to radiators to minimise the risks of people burning themselves. There was range of other risk assessments in place for a variety of risks including pressure area care, falls, and nutrition. The assessments were comprehensive and where risks had been identified appropriate action had been taken to minimise the risk. For example, where people had been identified as being at risk from pressure sores, pressure relieving equipment was being used.
There was no evidence in any care records to confirm people or their representatives had been involved in planning their care or treatment. Staff told us people had been warned decorators would be coming into their rooms. However, there was no evidence people had been consulted about the work. There was no evidence that people had been consulted individually about CCTV cameras being used in their bedrooms. Placing a camera in someone’s bedroom, not only infringes on the person’s privacy, but on the privacy of anyone entering that room. This raises a number of issues, including privacy, consent, and how the personal information recorded would be used.
There were no alternative strategies for consulting with people who were unable to understand spoken or written language. For example, pictures or photographs were not available to assist people in making an informed choice. However, people told us “I’m absolutely happy here…it’s my home and I wouldn’t change anything..anything I want I just press the bell…everybody’s very kind and considerate and I think they’re wonderful”
People’s comments varied when they were asked about complaints. One person said “It’s brilliant. I have no complaints at all. They get on and do what needs to be done, whether it’s haircuts, diabetic foot care or helping with getting funding. If I had any complaints I’d go to (the registered manager or deputy manager)…It’s been a breath of fresh air since my (relative) came here”. But another person said “I don’t know who I’d complain to, you have to make an appointment to see any managers”. The registered manager and deputy manager told us this was not the case and anyone could speak to them at any time.
People’s experience of social interaction and activities was mixed. Social engagement was limited and irregular depending on where people spent their time. Staff told us there was little time to spend with people just chatting and interacting in their own rooms. We spent some time There were some organised activities on offer including music and art sessions that took place in the main lounge. We spent some time in the main lounge completing a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw that the majority of interaction was task orientated, for example, asking people if they wanted drinks or offering personal care. However, there were some good interactions with people and staff discussing how to say ‘thank you’ in different languages.
We saw that a series of audits were being completed, but these did not always show that when issues had been highlighted, they had been addressed. However, some other audits clearly showed that action had been taken in response to identified issues.
People were protected from the risk of abuse because staff had the knowledge of how to identify and report suspicions of abuse. People were protected by robust recruitment procedures. The provider had a policy which ensured all employees and volunteers were subject to the necessary checks which determined that they were suitable to work with vulnerable people.
People were protected from the risks of unsafe medicine administration. People got the medicines they were prescribed, and on time.
Medicines had been stored safely and appropriately. People’s rooms had been fitted with lockable medicine storage cupboards and their individual medicines were stored in these. People were protected from the risks of cross infection.
People’s care plans were well maintained and regularly reviewed. They contained comprehensive assessments of the person’s needs and detailed instructions for staff on how to meet the needs. For example, one person’s care plan stated they liked to have a box of cards on their bed and they liked the TV on. When we visited the person we saw that these directions had been followed.
People benefited from a well-trained team of staff that were able to meet their needs effectively. Staff received a variety of training including moving and transferring, infection control, end of life care and safeguarding adults. They also received training in caring for people living with dementia. Staff treated people with kindness, affection and patience. Staff were skilled in speaking appropriately with people, including those living with dementia. People’s privacy and dignity was upheld. All personal care was provided in private and staff took care to co-ordinate people’s clothing choices and preserve their dignity. We saw people’s nails were clean and hair was groomed. People’s needs were met in a manner that was responsive to their individual needs. Staff told us about people’s needs and how they met them. They were able to tell us about individuals’ preferences. For example, that one person liked a fried breakfast every morning.
Health and social care professionals told us they felt the nursing care at the home was good and people we spoke with told us they received the medical care they needed.
Staff understood the principles of the Mental Capacity Act 2005 (MCA) and that people should always consent to their care. Staff were patient, kind and understanding in their approach. We heard choices being offered to people. We observed lunchtime for ten people in the ground floor dining room. They had a good choice of food, all cooked on the premises. There has been a recent change to the interpretation of the deprivation of liberty safeguards. The registered manager had made appropriate applications to the local authority in order to comply with the changes and ensure people were not deprived of their liberty without proper authorisation.
Environmental improvements included new lighting and redecorations throughout and brown doors had or were being painted white. The corridors particularly in the dementia unit had pictures, photographs and some sensory collages on display on the walls. This meant the home was light and bright and provided people with a more suitable environment.
The registered manager and deputy were very open and approachable. The main office was located in a central position which enabled people to speak with them at any time. Staff told us they felt well supported and encouraged to do a good job. They told us they were very happy working at Palm Court. They typically said ‘I love it here’ when asked whether it was a good place to work. They told us they had confidence that the management would sort out any concerns they might have.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.