CQC report explained · a nursing home
What the CQC found at Palm Court Nursing Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, August 2023
Palm Court Nursing Home is rated Requires Improvement; inspectors found safer staffing and a cleaner home, but ongoing problems with care records, person-centred care and oversight.
This was an unannounced follow-up inspection on 10 and 12 July 2023. Inspectors observed care, spoke with people, relatives and staff, and reviewed care records, medicine records, recruitment files and quality checks.
The home had enough staff, and improvements had been made to cleanliness, infection control, the building and new admissions. Staff generally knew people well, understood safeguarding procedures and supported people to make choices.
However, records were often incomplete or conflicting. Accidents and incidents were not always reported or investigated properly. Activities were limited, some staff did not respond well when people were upset, and relatives had not been involved in care planning. The service remained in breach of Regulations 9, 12 and 17.
The overall rating stayed at Requires Improvement. Safe, Responsive and Well-led were also rated Requires Improvement. Effective and Caring were not reviewed during this visit, so their earlier ratings carried over.
Enough staff
Inspectors found enough staff to support people safely, with good staff presence and no delays in answering call bells.
“There were enough staff to support people safely. People did not have to wait for call bells to be answered” from the report
Cleaner environment
The home was cleaner and more hygienic than at the previous inspection. Staff used protective equipment appropriately and recorded cleaning.
“The home was clean and hygienic, and staff recorded areas they had cleaned.” from the report
Health risks understood
Information about supporting people with epilepsy and seizures was clear and specific. Staff knew what to do in an emergency.
“Health risks to people were well managed. For example, where people lived with epilepsy and were prone to seizures, information on how staff should support the person in the event of a seizure was clear and detailed.” from the report
Kind interactions
Although the response to distress was inconsistent, inspectors also saw staff being kind and respectful, including during mealtimes.
“When staff spoke to people, they were kind and respectful.” from the report
Inaccurate care records
seriousDaily records did not reliably show the care people received or what happened during the day. Care plans also contained conflicting information about risks and moving people safely.
“People's daily records did not accurately reflect the care and support they were receiving or events that happened throughout the day.” from the report
Incidents not always reported
seriousAn incident involving three people was found in a handover sheet but had not initially been reported to management, investigated or referred to safeguarding.
“Accidents and incidents had not always been responded to appropriately by staff.” from the report
Limited activities
needs fixingPeople spent long periods without interaction or engagement. Relatives said there were not enough activities for their family members.
“People spent long periods of time without interaction or engagement from staff.” from the report
Inconsistent response to distress
needs fixingSome staff did not respond appropriately when people were upset. Care plans did not explain clearly what reassurance or support worked for each person.
“Some staff ignored people and didn't interact with them, other staff repeatedly told a person to sit down when they tried to stand up.” from the report
Weak oversight
seriousAudits had not identified repeated problems with medicine records, care plans and daily recording. Several safeguarding concerns were also reported to the regulator late.
“Governance processes were not always effective in identifying concerns.” from the report
- 01How will you make sure care plans and risk assessments give staff one clear and up-to-date set of instructions?
- 02How are accidents, incidents and safeguarding concerns now reported, investigated and notified to CQC?
- 03What activities are now available for people who are often left without interaction?
- 04How will staff be taught and checked on the best way to support each person when they are anxious or distressed?
- 05When will relatives be invited to care reviews and relative meetings?
This was a follow-up focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings carried over. This explanation was written from the published report of 12 August 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, February 2023
Palm Court Nursing Home was rated Requires Improvement, with serious leadership failures and risks involving safety, records and person-centred care.
This was an unannounced focused inspection. Inspectors visited on 5 and 7 December 2022, spoke with people, relatives, staff and a professional, and checked care plans, medicines records and quality checks.
The home was not always safe. Inspectors found broken fixtures, unsafe use of bed rails, poor cleanliness, incomplete risk assessments, weak fluid monitoring and unexplained injuries that had not always been investigated. Medicines were mostly managed safely, but records for topical creams needed improvement.
Care was not always suited to people's needs or preferences. Care plans were not consistently up to date, some admissions were poorly managed, oral hygiene support was inconsistent and activities were limited for some people. The home was rated Requires Improvement overall, with Safe and Responsive also Requires Improvement, and Well-led rated Inadequate.
Kind interactions
Staff generally spoke kindly and respectfully. Relatives and people gave positive feedback about staff.
“When staff spoke to people, they were kind and respectful.” from the report
Staffing and recruitment
Inspectors found enough staff to support people safely and found that recruitment checks were completed.
“There were enough staff to support people safely.” from the report
Most medicines managed safely
Storage, administration and disposal of medicines were safe, and medicine records were completed accurately. Staff had training and competency checks.
“There were safe arrangements for the storage, administration and disposal of medicines.” from the report
Communication support
People had communication plans, and staff supported the use of glasses, hearing aids and other communication aids where needed.
“People had clear communication plans to inform staff how best to communicate with them.” from the report
Complaints handled
The home had a complaints process and kept a record of complaints, concerns and the action taken.
“The registered manager kept a log of complaints and concerns received and recorded how each was addressed and actioned.” from the report
Safety risks
seriousBroken fixtures, unsafe bed rails and incorrect call bell information created risks of injury or delayed help. Some risk assessments and investigations were incomplete.
“People were not always safe from environmental risks.” from the report
Poor cleanliness
seriousInspectors found dirty bathrooms and bedrooms, strong smells of urine, unsuitable storage of protective equipment and other infection control risks.
“The environment was not always clean or hygienic.” from the report
Care not consistently personalised
seriousCare plans were not always current or specific to the person. Some people did not receive appropriate support with admissions, oral hygiene, activities or engagement.
“People were not always receiving person-centred care.” from the report
Weak records and checks
seriousRecords did not always show the care people received or the risks they faced. Audits failed to identify problems, and earlier improvement actions had not been completed.
“Quality assurance processes were not effective and did not identify risks to people's safety.” from the report
Incomplete notifications
needs fixingThe provider had not always told CQC when Deprivation of Liberty Safeguards authorisations had been approved. Inspectors identified eight missing notifications.
“We identified 8 people with DoLS authorisations that CQC had not been notified of.” from the report
- 01What has been done to assess every person's need for bed rails and to ensure rails have the correct bumpers?
- 02How are cleanliness, infection control and the condition of bedrooms and bathrooms checked every day?
- 03How will you make sure care plans, fluid charts, bowel charts and daily records are accurate and updated promptly?
- 04What new checks are now used when someone moves into the home, including personal care, toiletries, oral hygiene and belongings?
- 05What activities and regular one-to-one engagement are available for people who spend time in their rooms?
This was a focused inspection of Safe, Responsive and Well-led; Effective and Caring were not inspected and their previous ratings were used in the overall rating. This explanation was written from the published report of 2 February 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Palm Court Nursing Home
11 rated inspections over 8 years: the service has held its Requires improvement rating throughout.
- August 2023Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- February 2023Requires improvementstayed Requires improvementSafe: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- December 2021Requires improvementSafe: Requires improvementWell-led: Requires improvement
- April 2021Inspected but not ratedSafe: Inspected but not rated
- September 2020Requires improvementstayed Requires improvementSafe: Requires improvementWell-led: Requires improvement
- June 2019Requires improvementup from InadequateSafe: Requires improvementResponsive: Requires improvementWell-led: Requires improvement
- June 2019Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- January 2018Requires improvementup from InadequateSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2017Inadequatestayed InadequateSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: Requires improvementWell-led: Inadequate
- November 2016Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementCaring: Requires improvementResponsive: InadequateWell-led: Inadequate
- August 2015Requires improvementstayed Requires improvementSafe: Requires improvement
- July 2015Requires improvementSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: Requires improvementWell-led: Requires improvement
- September 2014
Report published without a new overall rating.
- July 2014
Report published without a new overall rating.
- December 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- July 2012
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 27 January 2011.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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