Porthgwara Nursing Home is a ‘care home’ that provides nursing care for a maximum of 20 adults, of all ages, with a range of health care needs and physical disabilities. At the time of the inspection there were 19 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
There was a registered manager in post who was responsible for the day-to-day running of the service. 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.
The management team demonstrated an open, transparent and reflective leadership style. They provided visible direction and a person centred approach to their staff teams. They exhibited a passion for providing a high quality service, which continually developed in order to meet people's needs in a holistic manner.
Professionals were highly complementary about the standard of care provided by the service. For example; “Porthgwara is an excellent nursing home with a conscientious manager who strives for the very best care for her residents. My patients in the home are well cared for in all respects,” and “All residents are well cared for, safe and happy with a holistic approach to their care.” and “This is an excellent well run home which cares for its residents with compassion and expertise.”
Staff demonstrated an exceptionally caring, compassionate and kind attitude towards people who lived at Porthgwara. People were highly complementary about the care they received from competent staff. There were many examples of how the caring approach of staff had a very positive impact on people’s lives. People told us; “It’s as near to home as you can get.”
Without exception family members all spoke extremely positively about the service their relatives received. They told us that their relative was very safe living at the service and that staff were kind, friendly and treated people in a way they could not have imagined. They told us that the registered provider, manager and staff were always available and approachable. For example, a relative commented; “I feel that not only my mother but I too, am totally supported by the Porthgwara family of management and staff.”
Relatives told us how well staff understood their family members. For example some people’s ability to communicate was affected by their disability but the staff were able to understand and provide for their needs effectively. Staff knew people’s care and support needs very well. A relative told us; “[Staff members name] can get mum to talk in a way that I can’t, they have just clicked. She knows my mums ways so well. It’s so lovely to see.”
The village of Coverack had experienced an extreme flood a few months before the inspection which cut off the village from the rest of the county. This had caused damage to the property and limited their access to utilities and the provision of essential supplies to the service. The road was assessed by the emergency services as being so damaged that staff could only access the home with emergency personnel escort. It was suggested at the time that people might have had to be airlifted out of the service to a safer location, however there would have been a serious risk to people’s health if this occurred. The owners and staff were highly committed to keeping people safe within the service and worked extremely hard with emergency services, contractors, food suppliers, medical services and health and social care professionals to ensure the service could continue to run as safely and smoothly as possible. A staff member commented; “When we had the storm some staff lost everything, their homes, but staff wanted to come to work and when you did, it put a smile on your face. It’s not hard, everyone here cares for each other, the residents, staff and the managers.”
Feedback from the emergency services, contractors and the Head of Adult Social Care was exceptionally positive about how well the owners and registered manager ensured that people continued to receive high quality care despite these extreme circumstances. They also praised the staff for their commitment in getting to work over such difficult terrain, and with their own personal circumstances, which meant people could continue to be cared for at the service.
People told us that despite the flood and some water entering the service they had always felt safe. One person commented; “I was lying in my bed as I can’t move, and I saw the water coming in through the patio doors of my room. Staff were fantastic. I knew I was safe, staff wouldn’t have it any other way.”
There was a calm and relaxed atmosphere in the service throughout the days of the inspection visits. We observed people had an excellent relationship with staff and staff interacted with people in an exceptionally caring and respectful manner. People were observed moving around the service without any restrictions. Staff were always available but discreet in their presence so people’s personal space was not impacted upon.
Safeguarding procedures were in place and staff had a good understanding of how to identify and act on any allegations of abuse. Incidents were logged, investigated and action taken to keep people safe. Risks to people’s health and safety were assessed and clear plans of care put in place to help keep people safe. These had been developed to minimise the potential risk of harm to people during the delivery of their care. Risk assessments had been kept under review and were relevant to the care provided.
There were always enough staff available to ensure people received continuous, attentive and discreet care and support. Staff had all the time they needed to respond to people’s choices as well as meeting their care and support needs in a way that suited the person. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. For example, supporting people to move around the service both inside and out and by having the time to let the people take the lead and control of what they wanted to do, when they wanted to do it.
People were involved in the recruitment process as the management team felt it was essential that people had a ‘voice’ in who was recruited. Recruitment checks were carried out to ensure suitable staff were employed to work at the service.
Staff were supported by a system of induction, supervision and appraisal. The registered manager worked in partnership with health and social care organisations and Further Education establishments to ensure practice remained up to date. Staff received training relevant for their role and there were excellent opportunities for continued training support and development in the area of dementia care and specific health conditions.
Management and staff had a good understanding of the underlying principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice.
The manager used effective systems to record and report on, accidents and incidents and take action when required. These events were reviewed in order to help reduce the risk of them happening again.
People and their families were given information about how to complain. There were effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed.
A fundamental aim of the home was to promote people's quality of life by providing positive opportunities for people to live life to the full. People were encouraged to maintain and develop interests which were important to them and this contributed to people living meaningful lives. The provider had established very strong links with the local community and hosted numerous events which had benefitted the people who lived at the service. For example, the local parent and toddler group held sessions at the service, the service hosted a garden party to which the community was invited as well as regular coffee mornings to raise money for charity. The providers believed that they needed to be part of and support their local community, and were keen to be involved in local projects. This demonstrated that the provider was committed to improve not just the lives of people living in their home but in the wider community and they were trying to positively influence and change the whole care sector in their area.
There were extremely effective quality assurance systems in place to make sure that any areas for improvement were identified and addressed. The registered provider was visible in the service and regularly observed and talked with people to check if they were happy and safe living at Porthgwara Nursing home. The service had a monthly Residents Association which fed into the managers meetings. This meant people were able to contribute ideas and suggestions and were fully involved in how the service was run.