Portelet Lodge Care Home

On this page

• 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.
At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement.

This meant some aspects of the provider were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was in breach of legal regulation in relation to safe care and treatment.

This service scored 59 (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 listened to concerns about safety and investigated and reported safety events.

Staff told us they knew how to raise concerns with themanagement. One staff member said, “I have opportunities to raise concerns if I identify any.” Another staff member told us, “Staff can raise concerns with superiors or management, and feedback is taken seriously.”

The provider had a system in place to record incidents and near miss events. Actions to prevent or minimise the probability of the event occurring again were completed.

The provider used a communication application to share information with staff, such as reminders and information on lessons learnt.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

The provider had a system in place to ensure people’s documentation was available in case of an emergency hospital admission. However, we found some people’s care plans and risk assessments were not correctly updated following a hospital discharge. This meant staff were not always given most up to date information on people’s mobility needs and information on how to support them.

For example, records showed 1 person was not supported to mobilise following their hospital discharge. The provider could not be assured staff supported them to use the equipment in line with their assessed needs. This meant the person was no longer able to mobilise independently. The provider contacted external professionals to organise a reassessment of their needs and to review their general health.

A health and social care professional told us, “We have found staff proactive when residents move between providers or require changes to their care arrangements, helping to maintain safe systems and minimise disruption.”

Staff told us they knew when to contact an external professional. A staff member said, “I speak with healthcare professionals on a daily basis about residents’ health and care needs.”

The management team understood their responsibility to notify and work with relevant statutory agencies should safeguarding events occur.

Staff had safeguarding training and confirmed they understood how to keep people safe. Staff told us they felt people were safe living at the service. One staff member said, “I believe our residents are safe because we follow care plans, complete risk assessments, administer medication safely and we report concerns immediately. We also encourage our residents to make choices while ensuring risks are mangedappropriately.” Another staff member told us, “I believe residents are safe. There are clear safeguarding policies in place, and staff are trained to recognise and report any concerns.”

Provider made necessary safeguarding referrals when required.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). All legal applications had been made in accordance with DoLS and the provider improved their overview of the already made applications.

The provider did not work well with people to understand and manage risks. They did not provide care to meet people’s needs that was safe, supportive and enabledpeople to do the things that mattered to them.

Risk assessments were undertaken for risks such as risk of malnutrition or falls, however these were not always accurate or care plans in place to mitigate these risks were not always followed.

Some people were cared for in bed and did not have access to their call bell to summon staff when needed. Their risk assessments were not person -centred and did not assess people’s individual abilities and circumstances. We also observed some people were not always able to use their call bells and alternative measures had not been considered. Care plans contradicted the information in people’s risk assessments and would often state call bells were kept within reach and people could use them.

This meant people were not always able to summon the help they needed, and care was not always accessible and timely for those who were most likely to have difficulty accessing care.

Staff did not know how often they should check on people who were cared for in bed. For example, for 1 person, a staff member told us they thought it was 2 hourly, however the risk assessment in place stated the person should be checked on hourly. There were no specific tasks on the electronic care planning system to prompt staff to check on people who were in their bedrooms. Records showed some people were left on their own for longer than 2 hours at a time.

The provider did not ensure there was an effective system in place to check on people. This put people at increased risk of avoidable harm.

Risk assessments for 2 people prescribed anticoagulant blood thinners were put in place during the inspection.

In response to our feedback the provider started reviewing people’s risk assessments to ensure they are reflective of people’s needs.

We received mixed feedback from relatives in relation to how safe the provider was.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

During our visit we observed shortfalls in the environment. The provider was responsive to our feedback and addressed these promptly. For example, some wardrobes were not attached to the walls. We also observed 1 fire exit was not alarmed which posed risk to people. The provider responded immediately to our feedback.

The provider implemented some safety measures, such as covers on the radiators and window restrictors.

The provider created a weekly walkabout document for the management to ensure they could identify environmental concerns and arrange repairs. A staff member said, “We report any issues to our manager; she then reports the issue to the maintenance team. The issues are usually addressed promptly.”

Some parts of the service were in need of redecorating. The provider created an improvement plan following our inspection feedback with the aim of creating safe, homely and dementia‑friendly environment.

The fire risk in the provider was regularly assessed by external professionals. The provider had organised for necessary works to be completed, however not all actions had been completed within recommended timeframes. This had not been picked up by the provider’s oversight processes. The provider created an action plan to address all the necessary works following our feedback.

People had Personal Emergency Evacuation Plans (PEEPs) in place to provide information on how they would need to be supported in the event of an emergency at the service.

We observed air flow mattresses, used to prevent pressure sores to skin, were not always checked and adjusted to people’s weight. This was addressed by the provider, and all people were weighed and their air flow mattress settings checked.

The provider did not ensure enough staff were deployed to meet people’s needs. Staff were suitably skilled and supported through supervisions and recruitment processes were safe.

The provider had a system to determine the number of staff required in relation to people’s needs. However, the system was inaccurate and had been completed incorrectly. It did not account for people who needed 2 members of staff to support them at the same time, people’s support with medicine or the need for emotional support and assurance. The system also indicated the provider needed more staff at certain times of the day than were scheduled to work. We found that some tasks, such as supporting people with 2 staff members and administering medicines, had been completed. However, not all people's emotional needs were met. Due to the inaccuracies in the staffing tool and the incorrect calculation of staffing hours, the provider could not be assured that there were enough staff to consistently meet people's needs safely and effectively.

We observed staff supporting people and meeting their basic needs. People wore clean clothes and staff spoke to them in a kind manner. However, some people sat in the lounge for most of the day, without much to do. Staff tried to support people to engage in prearranged activities, however they did not have the time to do so for extended periods of time. People were not supported to access the garden and there were no outings planned. People who were nursed in bed were left on their own without an option of joining in activities happening in the lounge or 1 to 1 support to complete a personalised activity.

Relatives told us they did not think their family members were offered the support they needed, including accessing the garden.

Staff were recruited safely and the required checks were carried out on staff before they commenced their employment. This included enhanced Disclosure and Barring Provider (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

Staff confirmed they had regular supervisions and team meetings. A staff member said, “I do receive supervision and support from senior staff, and I feel able to raise concerns or ask questions when needed.” Records confirmed staff’s competencies were checked.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We observed the premises to be clean on both days of our inspection.

A relative said, “[Person’s] room is always really clean and tidy. [Person’s] bedding always changed.”

Personal Protective Equipment (PPE) was available to staff who understood the importance of infection prevention. A staff member said, “I have completed infection prevention and control training. I understand the importance of correct use of PPE and hand hygiene to reduce the spread of infection toprotect both the residents and staff.”

People received their medicines safely in the way prescribed for them, in a kind and caring way. Staff took time with people to make sure medicines were taken correctly.

There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security. Although the maximum and minimum temperature range was not recorded for the medicine’s fridge, it was set to alarm if it went out of range. We were told this would be recorded going forward, to ensure that medicines requiring cold storage were always being stored in line with manufacturer’s guidance.

When medicines were prescribed to be taken ‘when required’ there were person-centred protocols to guide staff when these might need to be given. Records were in place to show that risks were considered for people using higher-risk medicines such as flammable topical preparations.

Staff had training and competency checks to make sure they gave medicines safely. Regular medicines audits took place to identify any areas for improvement.