Palace House Care Home with Nursing

Incidents and accidents were not being managed safely, staff did not take appropriate action to manage accidents. The procedure to manage allegations of abuse was not always being followed. Not all safeguarding concerns had been dealt with appropriately and the relevant partners informed in relation to allegations of abuse. Risks were not always being managed safely. Records confirmed professionals were involved in assessments and reviews of people’s needs. relatives were confident about the staffing but said there had been a lot of changes recently.

Environmental checks were taking place but required improving, fire safety risk assessments had been completed but the PEEPs file had incorrect information in it in relation to the people who were living in the service.

Training records were seen but the matrix did not include all staff members on the duty rota. Staff feedback was mixed about the supervision provided to them; the supervision records did not confirm all staff had undertaken a supervision. Staffing numbers needed to improve to ensure there was sufficient staff in place to meet all people’s needs.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. Cleaning tasks and checks were not being completed in line with their schedules. The service did not always make sure that medicines and treatments were safe and met people’s needs.

Consent was recorded in some of the care records we reviewed these had been signed by the registered manager on the person and relative’s behalf. We saw evidence of DoLS (Deprivation of Liberty Safeguards) information however, these had not been updated where people’s needs had changed.

Care records had been developed but they did not always include accurate and up to date information about people’s individual needs. People were not supported safely to manage their nutrition and hydration needs, records about people’s assessed needs in relation to individual meal requirements had not been updated to reflect accurately what people required and some people’s weights were not being monitored as regularly as they should be.

There was evidence that professionals were visiting the service, but not all information in people’s care records was accurate in relation to these reviews. We saw professionals visiting during the assessment. The provider talked about the challenges in ensuring people had sufficient staff support according to their individual needs.The provider talked about the challenges working with partners in ensuring people had sufficient staff support according to their individual needs.

We observed kind interactions taking place however this was not always the case. Care records held information about people’s individual needs and choices however these required updating to ensure they reflected people’s current individual needs and choices.

There were some activities taking place, but these were basic. The communal lounge was not being supervised by staff at all times.

Information about how to support people with end-of-life wishes was seen. Not all staff confirmed people were supported with end-of-life care, the training matrix had details of staff training in end-of-life care. People were supported with access to professionals; we received feedback that some people required re assessing to ensuring they received the appropriate staffing to support their needs. Care plans were seen but these required reviewing as they did not reflect people’s current needs. Team meetings were taking place and there was some evidence of handovers taking place but not every day. There was a complaints policy, no formal complaints were recorded but a relative talked about the lack of action by the management team when they had raised a concern. The provider told us they would take action to address the concern.

The feedback about the management team and the support they provided was very mixed, some staff told us they felt supported others felt there was a blame culture and were not always valued staff members. The provider had developed an action and was working on this to make improvements in the service.

There was a range of policies and procedures that had been developed by an external company, these were up to date. The feedback from staff about the management, the support they offered and freedom to speak up was very mixed.

We could not consistently see any actions had been recorded to demonstrate their findings and the audits we reviewed failed to identify our findings from this assessment to enable actions to be taken.