Palmarium

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We reviewed all 8 of the quality statements in this key question

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

On occasions Relatives told us they shared information with the management and staff, but this was not acted on. For example, one relative told us that they raised a concern with the service but felt this was not listened to.

Staff told us they were able to discuss incidents when things had gone wrong and ways in which they could improve. One member of staff said, “We do reflect on things. We have meetings to discuss various strategies and talk about what we do and how we can improve. There are less incidents now.”

The provider had systems which enabled incidents to be reviewed by management teams at the service. The regional manager also reviewed incidents to make sure any additional resources needed were contacted. For example, the provider had behaviour support teams who could provide additional support and guidance for the staff at the service. Learning from incidents was discussed during staff supervisions or staff meetings.

Relatives told us that their transition into the service was positive.

Staff told us that they had been involved in people’s transitions into the service. Staff told us they had opportunity to gain knowledge of people’s needs from other care providers, such as their likes and dislikes. Staff told us they had been able to spend time with people before they moved in, which helped them gain an understanding of people’s needs. One member of staff told us, “When [person] came to the service it was not easy. We took things slowly. The transition helped me to understand [person] and reduce the risk of incidents.” Staff also told us if people had to go into hospital, they went with them. This meant people were supported by staff they knew well to try and reduce anxieties for them.

Healthcare professionals told us how they were involved regularly with people and care plans were implemented. However, some felt that access to the electronic system was difficult. This meant they could not always easily access the information they needed. This was due to the new electronic system being implemented and the service were working towards this being fully and easily accessible to all. Staff could provide documents in paper form if requested.

The provider had systems which meant people had staff with them when moving between services. Staff who new people well remained with them in hospital. Records were shared with healthcare professionals to make sure they had information on people’s individual needs. The provider told us they had worked hard to ensure transitions into the service from other providers were completed thoroughly. Staff were encouraged to visit people before they moved and read all information available on people’s health and care needs.

Relatives told us that they mainly felt people were safe. They did not always feel that incidents were shared with them in a timely way. For example, several safeguarding incidents had been raised over a 12 month period for an individual. One incident had occurred but relatives had not been informed immediately.

Staff told us they had received safeguarding training and knew how to report any concerns. They felt confident that managers took safeguarding seriously and acted on things they raised.

We observed people being supported safely in their flats and when moving around the service. People appeared to be comfortable and relaxed with the staff supporting them.

Safeguarding incidents had been recorded and reported to the local authority safeguarding team. The registered manager worked with the local authority to make sure all relevant actions were taken to keep people safe. The provider had a safeguarding policy which was made available to all staff. Safeguarding training was part of the induction for all new staff with updates and refreshers available at regular intervals.

Relatives told us they were contacted by the service to discuss risk and had opportunity to share information for risk management. People’s records demonstrated risks to their safety had been identified and recorded.

Staff knew how to access risk assessments and they were aware of risks to people’s safety. Staff told us how they supported people to set long and short-term goals to help people manage and understand risks. Staff also knew the importance of supporting people to take positive risks where safe to do so. One member of staff told us, “We are supporting [person] to do more, to take more risks and lead a fulfilling life.”

We observed staff supporting people safely and following people’s risk management plans. We also observed staff supporting people when planning for a visit in the community. Staff discussed people’s support arrangements and made sure they followed safety procedures.

People had risk assessments which gave staff guidance on how to support people safely. The plans had been regularly reviewed with people to ensure the measures in place were appropriate. The provider also regularly reviewed people’s risk assessments as part of their quality checks to make sure guidance was up to date.

Relatives told us that the environment was safe.

Managers and staff felt the environment was safe. Staff were responsible for carrying out some health and safety checks in the service. They told us any defects were reported and repaired. Staff told us external maintenance workers were booked to redecorate.

We saw that the environment was clean. However, some cleaning tasks were not on the cleaning schedules. This meant there was not a record that some areas had been cleaned. We raised this with the provider during our site visits and observed they were added to the cleaning schedules. During our site visits we observed work being carried out to improve external lighting at the service. The provider told us this was in response to feedback the external areas were too dark at night.

The provider had systems to ensure all areas of the environment were checked and maintained for people’s safety. This included checks to any equipment being used. Regular checks were carried out to fire systems and equipment needed in case of fire.

Relatives told us that they felt there were adequate staff available to support people safely.

Managers told us they had no vacancies and in addition had a number of relief staff they could use as and when needed. Managers told us they used agency staff at times to cover shifts when permanent staff could not be found. Staff told us there were enough staff. However, some staff felt that there could be more night staff to ensure if any incidents occurred they could be managed safely.

During our observations we saw there were enough staff to meet people’s needs safely.

The provider had completed all the necessary pre-employment checks for staff before starting work. These included a check with the Disclosure and Barring Service (DBS). When new staff started work, they received an induction, which included training and shadowing experienced staff. Records demonstrated staff had regular supervision and updates to training. One member of staff told us their induction had been good for them, they said, “They covered everything, first aid, nutrition, health and safety, it was good. Prepared me for the job.”

People and relatives told us that staff used personal protective equipment (PPE). Some relatives told us cleaning could be more thorough at times. However, they also told us they had noticed this had recently improved.

Staff told us that they had access to infection prevention and control training. Staff told us they had the PPE they needed and items such as hand sanitiser. Staff were also aware of the importance of infection prevention and control in food preparation. Staff told us they had guidance and training provided on how to wash their hands thoroughly.

We observed staff wearing PPE appropriately and when needed. We also observed staff disposing of their PPE in designated bins. Chemicals used for cleaning were stored in a locked cupboard.

The provider had an infection prevention and control policy, which was regularly reviewed and updated to reflect current guidance. All staff had the required infection prevention and control training and regular updates when needed.

Relatives told us they felt the medicines were handled safely. Care records showed that people’s preferences regarding how they took their medication were made clear.

Staff received training to administer medication and if they had and questions they would contact the GP or pharmacy to gain advice.

The provider had systems to record and audit medications administered. Where changes to medication occurred a record of any correspondence were kept. We saw evidence that medicines were stored securely at an appropriate temperature in people’s own rooms.