CQC report explained · a residential care home
What the CQC found at Palmyra
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- Inspectors found enough staff, suitable risk assessments, safe recruitment checks and appropriate systems for medicines and environmental safety. People and relatives said they felt safe.
- Effective?
- Good
- People's needs and choices were assessed, staff received training and support, and people were helped with food, healthcare and appointments. Inspectors found the home was working within the principles of the Mental Capacity Act.
- Caring?
- Good
- Inspectors observed kind and warm interactions. People were treated with dignity, involved in decisions and supported to have privacy, choice and independence.
- Responsive?
- Good
- Care plans included people's preferences, interests and communication needs. People were supported to take part in activities, access the local community and make choices about how they spent their time.
- Well-led?
- Good
- Inspectors found regular audits, meetings and feedback systems, with approachable and supportive management. However, not all incidents had been appropriately referred to the CQC.
What inspectors found, May 2019
Rated Good in all five areas; inspectors found safe, caring and personalised support, with some incidents not always reported to the CQC.
This was an unannounced inspection on 29 and 30 April 2019. The inspector spoke with seven people using the service, four relatives and staff. They also reviewed care records, staff files, audits and other management records.
The home supported 13 adults with enduring mental health conditions. Inspectors found enough permanent staff, suitable risk assessments, safe medicines systems and a clean, well-maintained environment. Staff were trained and people were supported to make choices, stay independent and use local community facilities.
People and relatives described the home as safe, settled and caring. Inspectors saw kind interactions and found that care was planned around people's needs, preferences and communication. The home was rated Good for Safe, Effective, Caring, Responsive and Well-led.
The home was rated Good at the previous inspection, published in October 2016. Inspectors found it still met the characteristics of Good at this inspection.
Enough familiar staff
Inspectors found enough staff to meet people's needs. The home did not use agency staff, so permanent staff covered sickness and absences.
“The service did not use agency staff; any sickness or absences were covered by permanent members of staff.” from the report
Kind and respectful care
Staff were described as caring and compassionate. Inspectors observed warm interactions and found that people's dignity and privacy were respected.
“We observed kind and warm interactions between staff and the people they were supporting.” from the report
Personal choice and independence
People helped shape their care, menus and activities. They were supported to make choices, access the community and spend their time in meaningful ways.
“People had autonomy over how they spent their time and participated in activities which were meaningful to them.” from the report
Good support for health and communication
The home worked with healthcare professionals and supported people to attend appointments. Care records included information about communication needs and how to support each person.
“This was important for people who were unable to communicate with healthcare professionals and needed an advocate to speak on their behalf.” from the report
Open management
Inspectors found audits, regular meetings and opportunities for people, relatives and staff to give feedback. Staff described management as approachable and supportive.
“The registered manager was supported by a deputy manager and both encouraged an open-door policy.” from the report
Some incidents were not reported
needs fixingInspectors found that not all incidents had been referred to the CQC as required. The manager said they had a better understanding of which incidents needed reporting in future.
“We did note that not all incidents had been appropriately referred to CQC.” from the report
- 01What checks do you now carry out to make sure every incident that must be reported is referred to the CQC?
- 02How many permanent staff are usually on duty during the day and at night, and what happens when staff are absent?
- 03How would you support my relative to make choices about their care, activities and daily routine?
- 04How would you support my relative with healthcare appointments and communication with healthcare professionals?
- 05How are relatives involved in reviewing care plans and giving feedback about the home?
This was an unannounced inspection covering all five key questions; the previous inspection, published in October 2016, also rated the service Good. This explanation was written from the published report of 31 May 2019 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, October 2016
Rated Good overall; inspectors found kind, responsive care, but medicines management was not always safe and the safe rating was Requires Improvement.
This was an unannounced inspection on 17 August 2016. Inspectors spoke with seven people living in the home, four staff members and the registered manager. They also checked care files, staff recruitment records, medicines records and other quality records.
People appeared relaxed and comfortable. Inspectors found enough staff, suitable safeguarding arrangements, personalised care plans and kind interactions. People were supported with their health, meals, activities and maintaining relationships.
The main weakness was medicines recording. Some handwritten directions on medicine charts had not been checked by two people, one entry was incorrect and photographs were not always available to help staff identify people. The overall rating was Good, but Safe was rated Requires Improvement. Effective, Caring, Responsive and Well-led were all rated Good.
Kind and respectful care
Inspectors saw warm interactions and found that people's dignity and privacy were respected. Staff knew people well and supported their independence.
“During the inspection we observed interactions between staff and people living in the home to be supportive, warm and genuine.” from the report
Personalised care planning
Care plans reflected people's routines, preferences, histories and goals. People were involved in creating and reviewing their plans.
“Care plans we viewed were specific to the individual person and were detailed and informative.” from the report
Prompt support and activities
Staff responded to health concerns and other requests in a timely way. Activities and trips were based on people's interests.
“We observed staff responding to people's needs in a timely way throughout the day.” from the report
Good staff support and teamwork
Staff had relevant training and support. Staff said communication was good and that they worked effectively as a team.
“Staff told us there was good communication within the home and that they worked as an effective team.” from the report
Medicine records
needs fixingSome handwritten medicine directions were not checked by two people. One entry was incorrect and photographs were not always available to help identify people. No medicine administration errors had occurred, but the safe rating was Requires Improvement.
“Not all safer medicine management practices were followed.” from the report
Incomplete recruitment records
needs fixingSome staff files did not initially contain application forms, photographic identification or references. Most documents were retrieved during the inspection, and one set of missing documents was supplied afterwards.
“Not all of the files contained application forms, photographic identification or references” from the report
Fire drill response
needs fixingThe most recent fire drill showed a poor response, with some people not responding to the alarm. The manager had arranged further fire safety work with the fire service.
“The last drill reflected that response was poor” from the report
- 01What changes have been made to medicine charts so handwritten directions are checked by two people?
- 02Are photographs now included with medicine charts, and how do you make sure staff can identify each person correctly?
- 03What happened after the poor fire drill response, and when was the next successful drill completed?
- 04Are all staff recruitment files now complete with applications, identification and references?
- 05How are care plans and medicine records audited now that the inspection found the medicines audit had missed these issues?
This was an unannounced comprehensive inspection covering all five questions and setting ratings for the whole service. This explanation was written from the published report of 12 October 2016 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 Palmyra
2 rated inspections over 3 years: the service has held its Good rating throughout.
- May 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- October 2016GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- May 2014
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- November 2010
Registered with the Care Quality Commission on 23 November 2010.
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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38 live-in carers within about an hour of Sefton
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,270 a week. 34 can care for a couple. 11 years' experience on average.
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.