We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We found a number of breaches of the Health and Social Care Regulations 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of the full version of this report.
This was an unannounced, comprehensive inspection that took place on 1, 2 and 15 July 2015. The inspection was carried out by two inspectors on the first day and one inspector on the second and third day. Shortly before the inspection we received some concerns about the service and, during that time, we spoke with one of the directors of Portelet Care Ltd and also the registered manager.
There were systems in place to monitor accidents and incidents in the home; however, some incidents that should have been raised with the local authority safeguarding team had not been referred. Steps were taken before conclusion of this inspection to retrospectively refer all incidents to the safeguarding team.
Dorset Fire and Rescue Service, who visited the home before we carried out this inspection, issued an Enforcement Notice under The Regulatory Reform (Fire Safety) Order 2005 with respect to fire safety measures at the home.
Action was taken to address other hazards that had been identified such as making sure the laundry room was locked, the garden made safe and that substances harmful to health were kept locked away from people living at the home.
The home had experienced difficulties in the preceding months in meeting staffing levels because of some staff leaving employment. Staffing levels were being maintained with the use of regular agency staff. Before conclusion of the inspection, the home introduced dependency tools to assist in calculating staffing requirements and had increased the night time staffing levels to better meet people’s needs.
There were robust staff recruitment systems in place to make sure that appropriate staff were employed at the home.
Medicines, in general, were managed safely at the home. It was agreed that the home would consider the use of pain assessment tools to assist in knowing whether people living with dementia were kept free from pain.
The home was working with the ‘Clinical Commissioning Group (CCG) in meeting infection control issues that had been identified.
Staff were knowledgeable about people’s needs and people’s consent was always sought about care and support where people had capacity to make decisions.
The records to reflect assessment and best interest decision making for people who lacked capacity to make specific decisions did not meet the requirements of the Mental Capacity Act 2005 and we have asked the service to address this issue.
The home had systems in place to ensure that staff received appropriate training for them to be competent in their role.
Although there was some choice provided to people concerning the food provided, improvements could be made. It was agreed that more meaningful choice would be introduced and people would be assisted through use of pictures of meal choices. People who had lost weight were referred appropriately to their GP for assistance.
Action was taken to address shortfalls in the physical environment, such as fitting of a new call bell system, replacement of damaged furniture, refurbishment of bathrooms and introduction of better signage on one floor of the home.
Overall, there was a team of capable and caring staff who knew people’s needs.
People’s needs had been assessed before they entered the home and care plans put in place for staff to follow. At the time of our inspection the plans were not up to date and some had not been reviewed to reflect people’s changing needs. However; before completion of this inspection we were informed that all the plans had been reviewed and made up to date.
We recommended that more be provided in the way of meaningful activities for people. At the time of inspection, there was a vacancy for an activities coordinator.
The home had a system for managing complaints effectively.
The home had been through a period of change of management that had resulted in a period of instability; however, a new manager had been appointed and an interim management team put in place. The interim management team were open and transparent and were working with other health professional and the CQC to make the necessary changes.