Palm Court Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Palm Court Nursing Home provides accommodation for up to 53 people in one extended and adapted building. Nursing care is provided to people who have nursing needs; most people were living with dementia. There were 25 people living at the service when we inspected. Since our last inspection the provider had agreed with the local authority that there would be no new admissions to the service until the health and safety arrangements were addressed.

At inspections carried out in September 2016 and June 2017 the home was rated Inadequate and placed and remained in special measures as there were continued breaches of Regulations. CQC took enforcement action in accordance with its procedures. We met with the provider and asked the provider to complete an action plan to show what they would do to meet the requirements of the Regulations. We received the provider's action plan and we followed up on breaches at an inspection in November 2017. At that time improvements had been made and although there was still a breach of Regulation 17, the home was rated Requires Improvement overall.

Our last inspection was carried out on 19 and 24 July 2018 and we rated the service Inadequate. The home was placed into special measures again. This was because we found breaches of Regulation 12 in relation to safety and Regulation 17 in relation to good governance.

We carried out this inspection on 13 and 14 February 2019 and found that although improvements had been made in many areas, there were still areas in relation to the management of medicines and to governance that had not sufficiently improved and were continuing breaches of Regulations 12 and 17. We also found that there was a lack of stimulation and meaningful activities for people and we made a recommendation to improve this area.

The registered manager had left their position in June 2018. 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. A new manager had been appointed and started in post on 2 July 2018. At the time of our inspection their application for registration was being processed and the manager has since become registered.

Concerns with the management of medicines mainly centred on the management of medicines prescribed on an as required (PRN) basis for the management of agitation as it was not always possible to see why medicines had been given. Linked with this was a lack of documentation in relation to records that demonstrated actions taken by staff to support people with behaviours that challenged before resorting to medicines. We found that whilst auditing had improved in many areas these had not identified areas we found on inspection, for example in relation to the management of medicines and shortfalls in recruitment records. Further time is needed to build on the progress made and to fully embed new systems into every day processes. Improvements were also needed to ensure people were offered regular opportunities for person centred activities.

Significant progress had been made in relation to the management of health and safety. All equipment was now serviced and inspected regularly and the records demonstrated that when faults were noted they were addressed in a timely manner.

Care plans provided detailed advice and guidance about how people’s needs should be met and we saw that staff were kind and caring and supported people in a way that suited their needs. One person told us, “Yes the staff are very kind

Palm Court Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Palm Court Nursing Home provides accommodation for up to 53 people in one extended and adapted building. Nursing care is provided to people who have nursing needs, some people were living with dementia. There were 27 people living at the service when we inspected, admissions had slowly increased following the last inspection as sanctions imposed by the local authority and a voluntary agreement by the provider until the service improved had been lifted.

At inspections carried out in September 2016 and June 2017 the home was rated Inadequate and placed and remained in special measures as there were continued breaches of Regulations. CQC took enforcement action in accordance with its procedures. We met with the provider and asked the provider to complete an action plan to show what they would do to meet the requirements of the regulations. We received the provider's action plan and we followed up on breaches at an inspection in November 2017. At that time improvements had been made and although there was still a breach of Regulation 17 the home was rated requires improvement overall. We asked the provider to complete an action plan to show improvements they would make, what they would do, and by when, to improve the key questions in well led to at least good.

This inspection took place on 19 and 24 July 2018 and was unannounced. The registered manager had left their position in June 2018. 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. A new manager had been appointed and started in post on 2 July 2018. They had yet to apply for registration with CQC.

At this inspection we found the provider had not ensured effective leadership and direction at the service. Improvements made at the last inspection had not been sustained. There were continuing breaches of regulations. The new manager had spent their first two weeks in post assessing the provision of care and had a detailed action plan of the matters that needed to be addressed. Following the inspection, the local authority confirmed that although the suspension on placements had been lifted following the last inspection, a temporary placement break had since been agreed with the provider that meant there would be no further admissions to the service until safety concerns identified at this inspection had been met, and there was mutual agreement to start admissions again.

Significant health and safety matters were identified that had the potential to place people and staff lives at risk. These were in relation to fire and gas safety. East Sussex Fire and Rescue service were asked to visit the service to assess the situation. Further work has since been carried out to ensure the safety of the premises.

Although during our inspection we saw people were treated with respect and dignity, some people told us this was not always the case. We found two incidents of unexplained bruising that had not been reported to the safeguarding team for possible investigation. Although there were good systems to assess the needs of people who had behaviours that challenged, the actual advice on how to support people in heightened anxiety was less clear. There were no protocols for the giving of medicines prescribed on an ‘as required’ basis for agitation.

We identified areas of record keeping that needed to improve to document more clearly the running of the home. The provider’s auditing systems had not identified areas of practice that n

This inspection took place on 27 November 2017 and was unannounced.

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

Palm Court Nursing Home accommodates up to 53 people in one extended and adapted building. Nursing care is provided to people who have nursing needs, some people were living with dementia. There were 22 people living at the service when we inspected, there had been no new admissions due to a sanction imposed by the local authority and by a voluntary agreement by the provider until the service improved.

At the last inspection on 6 and 15 June 2017 the service was rated ‘Inadequate’ overall and there were some continued breaches of Regulations. Following that inspection, we met with the provider and asked the provider to complete an action plan to show what they would do to meet the requirements of the regulations. We received the provider’s action plan and followed up the breaches of Regulations at this inspection.

Following our last inspection the provider had prioritised some areas that needed immediate attention including: medicines; staffing levels; staff training, especially in moving people safely and updating care plans. At this inspection we found their medicines systems had been reviewed and changed; care plans had been updated; more staff had been recruited and staff had received additional training. The provider said they wanted to concentrate on the immediate priorities and now planned to move on to other priorities including supporting people’s interests and hobbies and providing meaningful activities for everyone.

There was a registered manager at 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. The registered manager was a registered nurse and they had implemented some changes that had led to improvements including increased and more in depth checks and audits.

The service had been inspected five times since 2015. At the inspections in December 2015 and January 2016, June 2016 and September 2016 we found multiple breaches of regulations. At the inspection in September 2016 the home was rated as inadequate and placed into special measures. Following this inspection the CQC took enforcement action in response to the continued breaches of regulations. A further inspection took place in June 2017 and there were still breaches of regulations. The provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We returned in November 2017 to see if improvements had been made. We found that the service had improved; however, there were still breaches of the regulations.

At the last inspection the provider had failed to ensure that risk was managed safely and did not make sure people experienced person centred care that met their needs and reflected their personal preferences. At this inspection improvements had been made. Risks to people had been identified and assessed, however some assessments were contradictory and inaccurate and did not reflect the care and support that people were receiving. Some of the care plans were difficult to read and some had not been reviewed and updated to reflect peoples changing needs. However, staff knew how to provide the care and support that people needed. Other care plans contained detailed guidance regarding how to support people. Accurate and complete records were not maintained for all people. People's confidentiality was respected and their records were stored securely.

At the last inspection the pro

This inspection took place on 6 and 15 June 2017 was unannounced. Palm Court Nursing Home provides accommodation and personal and nursing care for up to 53 people with care and support needs related to age, who may also have a diagnosis of dementia. There were 21 people living in the home at the time of our inspection.

The home had a registered manager. 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.

The home has been inspected four times since 2015. At the inspections in December 2015 and January 2016, June 2016 and September 2016 we found multiple breaches of regulation. At the inspection in September 2016 the home was rated as inadequate and placed into special measures. Following this inspection the CQC took enforcement action in accordance with its procedures.

At this inspection we found the rating for the service remains ‘Inadequate’ and the service will continue to be in ‘special measures’. Although there had been some minor improvements, we found the provider and registered manager had not made the significant improvements expected and remain in breach of a range of regulations of the HSCA 2008 (Regulated Activities) Regulations 2014. The local authority was not currently admitting people to the home, due to the ongoing and significant concerns identified by CQC.

The provider and registered manager continued to fail to act on feedback provided by the local authority, an external consultant and CQC. They had not provided effective leadership and direction at the service. The required improvements had not been made with regard to activities and personalised care and these were continuing breaches of these regulations. People were not always treated a kind and caring way, and did not have their safety protected at all times. The provider and registered manager’s auditing systems had not identified areas of practice that needed to improve and their quality assurance and monitoring system continued to be ineffective

Staff did not consistently treat people with dignity and respect, although we did observe some good practice in this area. People did not always have their preferences and choices met, and people’s needs were not always accurately assessed or recorded in their care plans. People’s care needs had not always been properly identified and the most up to date and relevant information about each person was not available to staff, to help them meet people’s care needs. Care plans were complicated and did not consistently contain accurate or up to date information about the person. There was a risk staff would provide the wrong care for people because of this.

Although the provider had increased the amount of training available for staff, they did not make sure this training was effective. We observed staff using unsafe moving and handling techniques, as well as providing support to people that was not centred on their individual needs. Staff learning and competency were not assessed after training, so the provider and registered manager could not be assured that staff training had been effective.

Risk assessment and risk management practices continued to put some people’s health at risk. Senior staff and the registered manager were not clear about why they were assessing risk, or the purpose of a robust risk management plan to keep people safe.

Food was of good quality and people gave us positive feedback. However, people’s individual dietary needs were not taken into account when food was prepared, and people were not supported to have a positive mealtime experience.

Although there were more staff on duty since the last inspection, they were not always deployed appropriately. There were enough staff to meet people’

Palm Court Nursing Home provides nursing care, personal care and accommodation for up to 53 older people living with dementia. There were 30 people living at the home during the inspection; they were all living with dementia and required assistance with looking after themselves, including personal care and moving around the home safely. Some people were living with behaviours which may challenge themselves and/or others.

This inspection took place on 26 and 27 September 2016 and was unannounced.

The service has not had a registered managed since January 2015. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. A manager had been appointed nine weeks before this inspection and they informed us they would be applying to register with the CQC as the registered manager.

Palm Court Nursing Home consists of two older properties at the front that have been converted to provide bedrooms on the ground and first floor, some with en suite facilities, communal bathrooms, three lounges and a dining room. An extension to the rear has bedrooms with en suite facilities on the ground floor and the building has been further extended to link up with a newly converted property on the side of the original home. This provides bedrooms, with en suite facilities on two floors, communal bathrooms, a dining room and a large lounge. The provider wants to extend the number of people that can live in the service but this has not yet been registered with the commission.

The quality assurance and monitoring system was not effective. Improvements had not been made with regard to staffing, training, activities and personalised care; some of these were continuing breaches of regulations and, the provider’s auditing system had not identified areas that required improvements.

The manager and staff were open regarding their concerns about staffing at the home. They had realised this meant the care and support provided was task orientated at times and did not consistently take into account the needs of people living with dementia. Some activities were provided and people enjoyed spending time with staff. However, these were not personalised to each person, and there was no evidence they followed current guidance for best practice.

Risk assessments had been completed as part of the care planning process. However, they did not include all the information needed to plan care or relevant guidance for staff to follow to meet people’s individual needs. There were systems in place for the management of medicines, but nurses did not always follow appropriate guidelines.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff had knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards, and the manager understood the process for applications for DoLS. Some staff had attended safeguarding training and they knew how to keep people safe and protect them from abuse. People said they were comfortable and relatives told us they thought people were safe.

Staff supported people to make their own decisions about the food they wanted. People thought the food was good and choices were available. Relatives and friends could visit at any time, they were made to feel very welcome and said the staff were very good.

People used bedrooms in all parts of the home; some preferred to remain in their rooms or were supported to do so because of their health care needs, while others were assisted to move into the large lounge in the new extension.

A complaints procedure was in place. Staff addressed issues they could deal with at the time and referred other concerns to the registered mana

Palm Court Nursing Home provides nursing care, personal care and accommodation for up to 53 older people living with dementia. There were 23 people living at the home during the inspection; they were all living with dementia and required assistance with looking after themselves, including personal care and moving around the home. Some people were living with behaviours which may challenge others.

At the time of this inspection the local authority had an embargo on admissions to the home pending improvements to record keeping. We last inspected this service on 30 December 2014 and 12 January 2015. After that inspection we received new information with concerns in relation to people’s safety and insufficient experienced staff. As a result we undertook a focused inspection 15 June 2015 to look into those concerns. This report only covers our findings in relation to this topic. 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

There was not a registered manager in post. 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. Following the inspection we were informed that the provider was submitting an application to be registered as manager of Palm Court Nursing Home.

The provider is at present working as the manager and registered nurse until an experienced manager and registered nurses are recruited.

People told us they felt safe. Visitors said that the staff were kind, caring and attentive. Staff told us they felt supported and had good training.

There were enough staff to look after people. However we could not confirm that staffing levels were consistent and safe due to the lack of advanced planning of rotas and pending agency requests. We found that this is an area that requires improvement.

Staff had been safely recruited and were safe to work with people. Staff were effectively supported by the manager and colleagues. They received appropriate training to enable them to meet people’s individual needs.

People were looked after by staff who knew and understood them well. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. Risk assessments were in place to keep people safe. However, these did not prevent people who chose to take well thought out risks as part of maintaining their independence and lifestyle. The environment was safe for people who lived with dementia.

Medicines were managed safely and staff made sure people received the medicines they required in the correct dosage at the right time.

We carried out this inspection to follow up on a warning notices issued as a result of concerns identified at the last inspection.

This inspection was carried out by two inspectors.

The service currently has an embargo on admissions implemented by the local authority.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

Systems were in place to ensure that the management and staff had learnt from issues identified at previous inspections. This reduced the risks to people and helped the service, improve although not yet fully embedded..

If the service effective?

We found at this inspection that the service was effective. People told us, “The staff are always around if we need them”.

Is the service caring?

We saw at this inspection that staff were aware of people's needs and offered kind and considerate support. One person said, "The staff are very good, they know what we need”.

Is the service responsive?

A range of social activities were available for people to join in if they wished. Support was flexible and we saw that people made choices.

Is the service well-led?

We found that staff we spoken with were clear about their roles and responsibilities, and they had a good understanding of people individual needs.

We carried out this inspection to look at the care and treatment that people living at the home received. At the last inspection on 15 October 2013 we found that there were inconsistencies in the care plans and associated documentation and that appropriate infection control systems were not in place. We found at this inspection that some minor improvements had been made, but there continue to be concerns about the services provided.

We spoke with ten of the people who lived at the home. However, some people were not able to tell us about their experiences of living at Palm Court, because of their complex needs. People told us they were very comfortable and that the food was good. One person said, “I am happy I moved in”.

We spoke with two relatives, five care staff, the cook, three housekeeping staff, the deputy manager and the provider. We reviewed four care plans and associated documentation; we looked at the systems in place for the control or infection, staff rotas and the processes used to assess and monitor the services provided.

We considered our inspection findings to answer questions we always ask:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

Is the service safe?

We found that during our inspection the service was safe. Relatives we spoke with told us they felt people who lived at the home were safe. Staff felt they provided care and support in a way that ensured people's safety, although they also recognised that this limited some people's choices..

Systems were in place to ensure the management and staff learned from events, such as incidents and concerns, and some of the issues identified at the last inspection had been addressed.

Is the home effective?

We found that during our inspection the service was not effective. People’s health and social care needs had been assessed, and they had been involved in this process, with the support of relatives or representatives. However, the support and care provided was not always based on people's choices and preferences, and may not meet people's individual needs.

Is the service caring?

We found that during our inspection that the service was caring. We saw that people were supported by kind, patient staff, who encouraged some people to make decisions about how they spent their time.

Is the service responsive?

We found that during our inspection that the service was responsive. We saw evidence that when people’s needs had changed, the manager had made appropriate referrals to outside agencies.

Is the service well-led?

We found during our inspection that the service was not well led. An effective quality assurance system was not in place, consequently shortcomings in the services provided were not identified and acted upon.

Staff we spoke with were clear about their roles and responsibilities. They had some understanding of the needs of people who lived at the home and they said they were able to talk to the management if they had any concerns. They also said that these concerns were not always addressed.

We used a number of different methods to help us understand the experiences of people who used the service. Some people had complex needs, which meant they were not able to tell us their experiences. However, those who spoke with us said, ‘I like living here’ and ‘the food is very nice’.

We saw that staff asked people for their consent before they provided care and support, and people were asked where they wanted to sit in the lounge.

We examined five care plans. We found that there were inconsistencies in the information recorded, and the way records were kept.

We looked at the policies and procedures for medicine management and how the service ensured people were safe.

Staff told us they had attended infection control training and there was evidence to support this. However, we found that appropriate systems to protect people from the spread of infection were not in place.

We reviewed the home’s recruitment procedures and found them to be effective.

We looked at care plans and daily records. We found that they needed to be reviewed and updated.

We spoke with eight of the people who used the service and observed the support offered by the care workers in the lounges and the dining room. People who were able to speak with us said they felt comfortable and the staff were very good. One person said, "I am very happy here."

We saw that staff offered support and care to people who used the service in a way that respected their privacy and dignity. We spoke with relatives and they were positive about the care and support offered in Palm Court.

We looked at the staff rota's, staff training records and activity records. We found that there were sufficient staff working in the home and they had attended training relevant to the support and care they offered. We observed that activities were provided for people who wanted to take part, although the care plans did not reflect this.

We used a number of different methods to help us understand the experiences of people using the service, because some had complex needs which meant they were not able to tell us their experiences. However those who could told us, ‘we have everything we need’, the staff were ‘very nice’, ‘the food is good’ and ‘we have what we want’.

Palm Court Nursing Home provides nursing care, personal care and accommodation for up to 53 older people living with dementia. There were 36 people living at the home during the inspection; they were all living with dementia and required assistance with looking after themselves, including personal care and moving around the home.

At the time of this inspection the local authority had an embargo on admissions to the home pending improvements to record keeping. At the last inspection we identified concerns in infection control.

This inspection took place on 30 December 2014 and 12 January 2015 and was unannounced.

The home was run by a registered manager who was available on both days of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. However, we were informed the registered manager had resigned from her post and would only be working for a further two weeks.

The premises were not secure and people’s safety was not ensured.

Risk assessments had been completed as part of the care planning process. However, we found they had not been reviewed on a regular basis with the involvement of people and their relatives. Records were kept of people’s food and fluid intake and the support they received if they remained in their rooms, but we found there were gaps in these records.

There were systems in place for the management of medicines, but nurses did not always follow relevant guidelines.

There were not always enough staff to meet people’s needs. This meant people had to wait for staff to assist them.

The system to monitor and assess the quality of service provided was not robust.

Not all staff had received up to date training, such as supporting people living with dementia. A range of activities was provided and people enjoyed spending time with staff. However, these were not personalised to each person, and there was no evidence they followed current guidance for best practice.

People said they were comfortable and relatives told us they felt people were safe. Safeguarding training had been provided for staff and they knew how to keep people safe and protect them from abuse.

Infection control training had been provided and staff demonstrated an understanding of how to protect people. The home was clean and there were on-going discussion with staff to ensure this continued.

Pre-employment checks for staff were completed, which meant that only suitable staff were working in the home.

People had access to healthcare professionals and records reflected any changes in support.

Staff had knowledge of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and the manager and provider understood the process for applications for DoLS.

People were encouraged to make their own decisions about the food they wanted. People thought the food was good and choices were available. Relatives and friends could visit at any time and were made to feel very welcome.

People thought staff looked after them and relatives felt staff were very good. Staff understood people’s specific needs and treated people with respect and protected their dignity when supporting them. People’s equality and diversity needs were respected and staff supported them to make choices about their own care and support.

A complaints procedure was in place. Staff addressed issues they could deal with at the time and referred other concerns to the registered manager or provider. However, one relative felt the management did not listen to their concerns and felt appropriate action may not be taken.

Staff felt supported by the registered manager, they were included in discussions about how the service could be improved and felt like active members of the team.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.