We carried out an inspection of Palace House Care Home on 30 and 31 October 2018. The first day was unannounced.

Palace House Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Palace House Care Home provides accommodation and care and support for up to 33 people. The service provides nursing care. There were 30 people living in the home at the time of the inspection.

Palace House Care Home is an extended detached older property which has retained many original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift. Car parking was available to the rear of the house.

At the time of our inspection, the registered manager was no longer managing the service. A new manager had been in post from August 2018 but had not yet applied to register with CQC. A registered manager is a person who has registered with 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.

At the last inspection on 1 and 2 November 2017, our findings demonstrated there was a continued breach of the regulations in respect of staffing; the service was rated Requires Improvement. The service had also been rated Requires Improvement following the inspections of March 2016 and March 2017. Following the last inspection, we asked the provider to complete an action plan to show what they would do to improve the service to at least good and to identify the date when this would be achieved.

During this inspection, we found improvements had been made. However, we found a breach of regulation 12 in relation to medicines management. Therefore, this is the fourth consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

People’s medicines were not always managed safely. The clinical commissioning group medicines optimisation team were supporting management and staff with making improvements. However, we found there were still some shortfalls in medicine management practices in the home and further improvements were needed. People received their medicines when they needed them and staff administering medicines had received training and supervision to do this safely.

Quality assurance and auditing processes were in place to help the manager to effectively identify and respond to matters needing attention. We saw evidence of regular monitoring that had identified shortfalls in the service and appropriate action had been taken to address the shortfalls. However, the audit tools had not identified the shortfalls found during the inspection in relation to medicines management. The manager addressed this following the inspection. People's opinions on the quality of care provided were sought. The provider had good oversight of the service.

We found people’s care records and staff members’ personal information were stored securely in locked cabinets and were only accessible to authorised staff. The manager could describe the improvements being made to systems and records in response to shortfalls found during the audits.

Risk assessments had been developed to minimise the potential risk of harm to people. They had been reviewed in line with people's changing needs. The manager was currently improving the incidents and accidents recording and monitoring systems.

Safeguarding adults' procedures were in place and staff had received training. Staff understood how to protect people from abuse and

We carried out an inspection of Palace House Care Home on 1 and 2 November 2017. The first day was unannounced.

Palace House Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Palace House Care Home accommodates 33 people in one adapted building. There were 29 people accommodated in the home on the day of our inspection.

Palace House Care Home is an extended detached older property which has retained a number of original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift. Car parking was available to the rear of the house.

At the time of our inspection the registered manager was no longer managing the service. A manager had been in post from 16 October 2017 and would be registering with CQC. 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.

At our last inspection on 22 and 23 March 2017 we found four breaches of legal requirements. We found shortfalls in risk management, staffing, maintaining accurate records and a continued shortfall in ensuring effective quality assurance and auditing systems. We also made recommendations regarding improving the provision of appropriate induction training for new agency staff and recording people's capacity and ability to make decisions about their care.

Following the last inspection, we met with the provider and asked them to complete an action plan to confirm what they would do and by when to improve the key questions Safe, Effective, Responsive and Well Led to at least good.

During this inspection we found improvements had been made to address the shortfalls in risk management, record keeping and quality assurance and auditing systems. However, our findings demonstrated there was a continued breach of the regulations in respect of staffing. You can see what action we told the provider to take at the back of the full version of the report.

We found a number of improvements had been introduced although we found they were in their infancy and needed to be embedded into practice over time. We will check this during our next planned comprehensive inspection.

People’s opinions regarding staffing numbers varied. The staffing levels were now being monitored to ensure sufficient staff were available at all times and additional staff were being recruited. Recruitment processes had improved. Staff training had improved and action had been taken to provide staff with adequate supervision and support.

We found people considered the service was managed well and they were happy with the improvements that had been made. New quality assurance and auditing processes had been introduced to help the provider and the manager to effectively identify and respond to matters needing attention.

The systems to obtain the views of people, their visitors and staff had been improved. People were encouraged to be involved in the running of the home and were kept up to date with any changes.

During this inspection we found there had been an improvement in the records relating to people’s care and support. We found the new care plan format and associated risk assessments had been introduced although we found some of the daily records relating to people’s care had been completed in an inconsistent way. In addition people had not been involved in the review of their care. The manager was aware of the shortfalls and further action was being taken to

We carried out an inspection of Palace House Care Home on 21 and 22 March 2017. The first day was unannounced.

Palace House Care Home provides accommodation and care and support for up to 33 people. There were 29 people accommodated in the home at the time of the inspection.

Palace House is an extended detached older property which has retained a number of original features. It is situated on the main road between Burnley and Padiham and is near to shops, churches, public transport and local amenities. Accommodation is provided on two floors with a passenger lift and chair lift access. On the ground floor there is a lounge and dining area with quiet seating areas. There are safe and well maintained gardens and seating areas for people to use. Bedrooms provided single occupancy and some had en-suite facilities. Bedrooms were located near to toilet facilities or were provided with commodes. Car parking was available to the rear of the house.

The service was managed by 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.

At our last inspection on 16 and 17 February 2016 we found the service was not meeting all the standards assessed. We found shortfalls in the management of medicines, recruitment practices and a lack of effective quality assurance and auditing systems. Following the inspection we asked the provider to take action to make improvements and to send us an action plan

We also recommended the service’s improvement plan dates were followed to make sure people lived in a comfortable and suitable environment and that the induction processes were improved.

During this inspection, we found some improvements had been made to the management of medicines, induction processes, recruitment practices, the environment and to the quality monitoring systems. However, we found there were still some concerns regarding the effectiveness of the quality monitoring systems. Our findings demonstrated there were four breaches of the regulations in respect of risk management, staffing, maintaining accurate records and ensuring effective quality assurance and auditing systems. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also made recommendations regarding improving the provision of appropriate induction training for new agency staff and recording people’s capacity and ability to make decisions about their care.

People told us they felt safe and staff were kind and caring. Safeguarding adults’ procedures were in place and staff understood how to safeguard people from abuse.

Improvements had been made to ensure people's medicines were managed safely and safe recruitment processes had been followed. Staff were provided with training and professional development and the process of formal one to one supervision was being reviewed. Agency staff were not given any formal induction to the home or made aware of the layout of the building which could place people at risk.

People living in the home and staff told us there were insufficient numbers of staff available to provide their care. We noted calls for assistance, particularly in the morning, were not always promptly responded to. We were told there were some difficulties and recent disagreements between staff members which had created low staff morale. The registered manager was aware of this.

The information in care plans and risk assessments was brief, lacked detail and some information had not been reviewed in a timely way. This meant that staff did not ha

We carried out an inspection of Palace House on the 16 and 17 February 2016. The first day was unannounced. This was the first inspection of the service following registration with the Commission in February 2014.

Palace House provides accommodation and nursing and personal care for up to 33 people. At the time of the inspection there were 27 people accommodated in the home.

The home is a large detached property situated on the main road between Burnley and Padiham in Lancashire. It is near to shops, churches, public transport and local amenities. There are safe and accessible gardens and parking is available for visitors and staff.

The service was managed by 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.

During this inspection visit we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to ineffective quality assurance and auditing systems, management of people’s medicines and recruitment processes. You can see what action we told the registered provider to take at the back of the full version of the report.

We also made recommendations about maintaining and developing the environment and the induction of new staff.

People told us they did not have any concerns about the way they were cared for. They told us they felt safe and were looked after. They said, “I have not seen anything untoward” and “I am looked after and treated very well.” One relative said, “I’m confident the staff are always the same whether I’m here or not; (my relative) is safe and looked after.” We observed staff responding to people in a friendly, respectful and caring manner. We noted staff showed concern for people’s comfort and well-being.

Staff were able to describe the action they would take if they witnessed or suspected any abusive or neglectful practice and had received training on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). This meant they had knowledge of the principles associated with the legislation and people’s rights.

People were happy with the care and support provided. They said, “There is always something going on and always someone to talk to” and “It’s a great place; staff take time to talk and spend time with me.” A visitor said, “I am very satisfied; it’s a nice place, a very happy place.”

Staff were knowledgeable about people’s individual needs, preferences and personalities and people were involved in making choices and decisions about their day. People were encouraged to be involved in the running of the home and were kept up to date with any changes.

People were encouraged to express their views during day to day conversations with management and staff and during reviews and meetings. They were aware of how to raise their concerns and complaints and were confident they would be listened to.

People told us they were given their medicines when they needed them. However, we found areas where improvements were needed to ensure people’s medicines were always managed safely.

The service had introduced clear recruitment and selection policies and procedures although we found the safe and fair process was not always followed.

People told us there were sufficient numbers of staff to meet their needs in a safe way. They felt staff had the skills to provide them with effective care and support and were happy with the care they received. We found a number of gaps in the provision of training. However a dedicated trainer had been appointed to help ensure staff were up to date with all training. Staff told us they were supported in their work. Improvements were needed to the induction processes for new staff.

People raised n

An adult social care inspector carried out this inspection. The focus of the inspection was to answer five key questions:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

During this inspection we spoke with five people using the service and two visitors. We also spoke with three care staff, a housekeeper, the deputy manager and the acting manager. We viewed records which included, three care plans and daily care records, policies and procedures, training records, staff rotas, menus and records of meals served, minutes from meetings and monitoring records.

We considered the evidence we had gathered under the outcomes. This is a summary of what we found:

Is the service safe?

Staff had received appropriate training and had access to 'safeguarding adults' and 'whistle blowing' procedures to help them recognise and respond to any signs of abuse or neglect. The management team was clear about their responsibilities for reporting incidents in line with local guidance and staff knew how to report any poor practice.

Staff had received training, and there were proper policies and procedures, in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards although no applications had been submitted. This should ensure people’s best interests were safeguarded.

People told us they were happy with the staff team and said there were enough staff. We found there were sufficient, skilled and experienced nursing, care and ancillary staff to meet people's needs.

Is the service effective?

People told us they enjoyed the food. Comments included, "The food is great and there is always a choice", "The food is very good and I get the diet I need" and "The food is alright". Catering staff were aware of people's dietary preferences and were able to provide specialist diets as needed. Records showed there was a choice of food and drinks available.

There were systems in place to monitor the quality of the service and to monitor staff practice in areas such as medication, care planning, infection control and environment. However, the audits were not completed on a regular and planned basis and it was not clear how improvements had been made where shortfalls had been identified.

There had been no recent customer satisfaction surveys sent to people using the service or their relatives. This meant people’s views of the current service were not up to date.

Is the service caring?

We observed staff interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us they were happy with the staff team and one person said, “Staff are brilliant; I can’t praise them enough”.

Most of the care staff had achieved a recognised qualification in care and all had received training to meet the needs of people living in the home. It was clear from our observations and discussions with people that staff had a good understanding of people's needs.

Care records contained useful information about people's preferred routines and likes and dislikes. This should help staff look after people properly and ensure they received the care and support they needed and wanted.

Is the service responsive?

There were opportunities for involvement in a range of suitable activities. People had been involved in discussions and decisions about the activities they would prefer and activities were arranged for small groups of people or on a one to one basis. Comments included, “There is always something to do but I am happy to do my own thing" and "I get involved if I am interested in what they are doing”.

People had been encouraged to express their views and opinions of the service through meetings and during day to day discussions with staff and management. There was evidence their views had been listened to.

People were confident they could raise any concerns with the staff or managers. However we found that whilst people’s concerns had been responded to, they had not always been clearly recorded. This meant it was difficult to determine whether there were recurring problems or whether the information had been monitored and used to improve the service.

Regular reviews were carried out to respond to any changes in people's needs and to ensure the level of care was appropriate. Records showed some people living in the home, or their relatives had been involved in the planning and review of their care but this was not always clearly documented.

People's health and well-being was monitored and appropriate advice and support had been sought in response to changes in their condition. People told us their health needs were met. Assessments of any risks were recorded, managed and kept under review. This would help to keep people safe from harm.

Is the service well-led?

The current acting manager had been in post since April 2014 and would be forwarding an application to register as manager. We were told an application to de-register the previous manager had been forwarded to the Care Quality Commission (CQC).

We were told the home had been visited by representatives from the organisation. However, without any records of these visits, we were unable to determine how the day to day management of the home and how the manager’s practice had been monitored.