Portelet Lodge Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The provider was in breach of legal regulation in relation to person centred care.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always ensure people’s needs were accurately reflected in their care plans.

The provider regularly reviewed people’s care plans and risk assessments, these reviews were ineffective. Records showed care plans had out of date and contradictory information about their needs. For example, 1 person who was cared for in bed had falls risk assessments in place stating they need to wear appropriate footwear with good grip and to ensure floors are dry and even.

Some people had additional needs which were not assessed. For example, 1 person was discharged from hospital with additional equipment in place. Healthcare professional visited the provider often and were called in to support the person with this equipment, however the provider did not have a person-centred care plan in place. The provider responded to our feedback and assessed person’s needs and produced relevant care plan and risk assessment.

The provider had closed-circuit television (CCTV) in place. We observed there were no visible signs placed in the budling to inform people and visitors CCTV was being used. Live stream of the camera placed in the lounge was displayed on a computer screen in the management office. People or their representatives were not consulted before CCTV was installed. It is a legal requirement for people to be consulted before CCTV is installed and used. The provider had the relevant training and policies in place for CCTV usage, however no associated documentation had been completed. The provider responded to our feedback by switching the CCTV off. The provider raised appropriate safeguarding incident with the local authority.

The provider did not always plan and deliver people's care and treatment in line with their assessed Speech and Language Therapy (SALT) requirements.

People were referred to the speech and language therapist (SALT). SALT is the Speech and Language Therapy who provide assessment of swallowing or communication difficulties for people with medical, neurological and surgical conditions.

People’s SALT requirements were not clearly communicated with the staff team which resulted in 1 person not being supported in accordance with their identified need. This was brought to the provider’s attention on the first day of our inspection. The provider failed to ensure an effective handover took place which resulted in staff not knowing how to support this person with their hydration needs. Ineffective handover and no clear guidance for staff meant people were put at risk of avoidable harm. In response to our feedback the provider introduced a new form for handover to support staff.

Staff were not always aware how to prepare food in line with people’s needs. The provider responded to our feedback and organised additional face to face training to address this shortfall.

We received mixed feedback regarding food at the service. A person told us the food was “very good”. However, a relative said, “The food is really not good.”

Staff confirmed they supported people with their meals and options. A staff member said, “In the aspect of food, I prompt them to make a choice and if they can't, I offer them several choices to choose from according to their care plan which takes into consideration their health and medical status.”

We observed staff explaining available menu options and encouraging people to eat. When required, physical support was provided.

The provider used evidence-based tools, such as MUST and IDDSI guidance, however did not follow the guidance associated with it.

Malnutrition Universal Screening Tool (MUST) is a standard check used to see if an older adult is at risk of being under-nourished. Higher MUST scores mean a person is at risk of malnutrition. IDDSI (International Dysphagia Diet Standardisation Initiative) standardizes food textures and drink thicknesses for people with swallowing difficulties (dysphagia).

The provider worked well across teams and providers to support people.

Staff confirmed they knew how to contact health and social care professionals when required. Records confirmed external professionals were contacted regularly.

A health and social care professional told us, “Communication with the home has been consistently very good, with staff maintaining regular contact.” However, another health and social care professional told us they were not always told when a person they came in to see had been admitted to hospital.

The provider supported people to manage their health and wellbeing by supporting them to access external professionals.

We found some people’s care plans were often contradictory and did not aid staff in regular monitoring of people’s health.

We received mixed feedback from relatives. Some relatives told us the communication between the service and them was poor and they were not always told when their family member was unwell. However, others confirmed they were told when their family member needed medical attention.

The provider was not promoting people’s mental wellbeing by encouraging them to be mobile and join in activities.

However, people were supported to see healthcare professionals when required. We observed health and social care professionals visiting the provider regularly.

People were supported to make healthier choices that promoted their wellbeing. For example, to reduce the amount people smoked.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

It is important to monitor people’s weight as any changes could indicate an underlying health problem.

The provider had an audit tool in place to support oversight and monitoring of people’s weights. This was completed incorrectly with outdated MUST scores and wrong weight documented. This meant the provider could not rely on this tool to identify people’s weight fluctuations increasing the risk of malnutrition and poor health.

The provider told us people whose MUST scores were higher than 1 were weighed weekly. Records showed this did not happen. The provider responded by weighing people on the second day of the inspection and making changes to the way they monitored people’s weights.

The provider did not always tell people about their rights around consent and did not always respect their rights when delivering care and treatment.

Relevant documentation in relation to people’s capacity and best interest decisions was completed. However, people’s capacity was not assessed in relation to the use of CCTV on the premises. The provider switched all the cameras off as a result of our feedback and reported this oversight to the relevant organisations.

Where necessary, people with legal authority or responsibility can make decisions within the requirements of the Mental Capacity Act (MCA). The provider had an effective system in place to ensure they had an overview of who can lawfully act on person’s behalf.

Staff confirmed they assumed people had capacity and involved them in making decisions about their care. One staff member told us, “If a person lacks capacity and needs care, staff follow the care plan, risk assessments, and best-interest decisions. We explain what we are doing, gain cooperation where possible, maintain dignity and respect, and ensure care is delivered safely and in the least restrictive way. Concerns are escalated appropriately to senior staff or healthcareprofessionals.” Another staff member said, “I have completed MCA training. It guides me to support individuals in making their own decisions wherever possible. I always presume capacity unless assessed otherwise and ensure that residents are involved in decisions about their care.”