Archived: Portland Nursing Home

Portland Nursing Home is a residential care home providing personal care to up to 40 people. The service provides support to older people with a range of health conditions. At the time of our inspection there were 24 people using the service. The accommodation is across three floors, with communal areas on the ground floor.

People’s experience of using this service and what we found

Call bells were not responded to in a timely manner as the system was not maintained by the provider. Medicines were not safely managed as temperatures were not routinely monitored, protocols were not in place for as required medicines and medicine records were not always clearly written or fully completed.

People were not always protected from the risk of abuse as incidents were not always reported. Fire safety risks had not always been assessed or actions taken to mitigate. Infection control in the laundry needed to be reviewed as it was unsafe.

Meals were not always well presented, and people were not always offered alternative options. Practice fire evacuations had not been completed regularly, storage was limited and impacted on accessibility to a bathroom. Two people were sharing a room and a solution had not been found to ensure this did not impact on relatives visiting.

People’s privacy and dignity were not always respected, and people were subjected to institutionalised practice. Bathing routines and other care needs were displayed in a communal area. We found a person sitting in a wheelchair without foot plates.

The complaints procedure was not clear, and records of complaints were not maintained. The provider had no analysis of complaints. People had complained and this had not been recorded. Relatives were not clear on complaints procedure, and one was worried about complaining. People were not engaged in activities and people spent most of their time in their rooms. People’s communication needs were not always fully considered.

Governance and quality assurance systems were ineffective, and the provider had failed to monitor and identify areas of improvement needed. There was no engagement with people or relatives to improve the outcomes for people.

People were not always supported to have maximum choice and control of their lives and did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection:

The last rating for this service was good (published 28 September 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have found breaches in relation to medicines management, the provider’s quality assurance systems, person centred care and handling of complaints. Please see the action we have told the provider to take at the end of the full version of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection on 6 October 2016 we identified shortfalls regarding the lack of stimulation for people and limited opportunity for meaningful, personalised activities. We asked the provider to tell us how they intended to address these areas. At this inspection we found the necessary improvements had been made.

A registered manager was in post and present on the day of the inspection. 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.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were personalised and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

There were policies and procedures in place to assist staff on how keep people safe. There were sufficient staff on duty to meet people’s needs; Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness and their privacy and dignity was respected.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely in accordance with current regulations and guidance by staff who had received training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

The provider had systems in place to assess the quality of care provided and make improvements when needed. People knew how to make complaints, and the provider had a process to ensure action was taken where this was needed. People were encouraged and supported to express their views about their care and staff were responsive to their comments.

At our last inspection on 4 April 2014 the service was found to be meeting all of the standards assessed and no concerns were identified.

A registered manager was in post and present on the day of the inspection. 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.

We identified shortfalls regarding inconsistent temperatures throughout the service and the lack of stimulation for people and limited opportunity for meaningful, personalised activities and have asked the provider to make improvements in these areas.

There were policies and procedures in place to assist staff on how to keep people safe. A sufficient number of staff were available to meet people’s identified care and support needs. Staff told us they had completed training in safe working practices. We saw people were supported with patience, consideration and kindness; and their privacy and dignity was respected.

People received care and support from staff who were appropriately trained and confident to meet their individual needs. They were also able to access health, social and medical care, as required. There were opportunities for additional training specific to the needs of the service, such as diabetes management and the care of people with dementia. Staff received one-to-one supervision meetings with their line manager. Formal personal development plans, such as annual appraisals, were in place.

People’s needs were assessed and their care plans provided staff with clear guidance about how they wanted their individual needs met. Care plans were person centred and contained appropriate risk assessments. They were regularly reviewed and amended as necessary to ensure they reflected people’s changing support needs.

Thorough recruitment procedures were followed and appropriate pre-employment checks had been made, including evidence of identity and satisfactory written references. Appropriate checks were also undertaken to ensure new staff were safe to work within the care sector.

Medicines were managed safely, in accordance with current regulations and guidance by staff, who had received appropriate training to help ensure safe practice. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately.

People were being supported to make decisions in their best interests. The registered manager and staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People were provided with appropriate food and drink to meet their health needs and were happy with the food they received. People’s nutritional needs were assessed and records were accurately maintained to ensure people were protected from risks associated with eating and drinking. Where risks to people had been identified, these had been appropriately monitored and referrals made to relevant professionals, where necessary.

There were quality assurance audits and a formal complaints process in place. People were encouraged and supported to express their views about their care; and staff were responsive to their comments. Satisfaction questionnaires were used to obtain the views of people who lived in the home, their relatives and other stakeholders.

Below is a summary of what we found.

Is the service safe?

We observed people were treated with respect and dignity by the staff. One person living at the home told us, "It's a homely place where you feel safe." Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. The service was clean and hygienic and systems were in place to reduce the risk of infection occurring at the home. Procedures were in place and special equipment was available, for example to evacuate the building if a fire occurred. This meant people were not put at risk in case of an emergency occurring at the home.

Is the service effective?

We found that people's needs were assessed and care files included information about people's diagnosed health conditions or disabilities. This meant that they received care that protected their welfare and safety. We found people's dietary needs were met and adequate amounts of food and drink were available. People and their relatives told us there was plenty of choice at mealtimes. People's needs were being met and we saw staff received appropriate training. Consent was obtained for people's care and appropriate arrangements made if people could not consent for themselves, for example due to dementia.

Is the service caring?

People told us they were happy with the care they received at Portland Nursing Home. One person's relative said, "It has a good reputation for the care they give. We've been very happy." We also spoke with a visiting professional who said, 'The care that I see when visiting the home is fantastic.' We observed that staff engaged well with people and gave them gentle encouragement with activities and tasks.

Is the service responsive?

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People told us they knew how to make a complaint if they were unhappy. They also told us staff responded well if they had any concerns. One person said, 'Sometimes things go wrong but the staff always listen and try to put things right.' People we spoke with and their relatives told that they were asked for their views about the care delivered at the home. We saw that activities were made available that were consistent with people's interests.

Is the service well-led?

The manager completed regular checks and audits of medication, infection control systems and other aspects of safety and practice at the home. They also delegated responsibilities to the deputy manager, nurses and other staff to ensure the home was safe and well run. The service has a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. People using the service, their relatives and other people involved with the service completed an annual satisfaction survey and records showed action was taken where any improvements were required .As a result the quality of the service was kept to a good standard.

We saw that people's care was planned and delivered in a way that met their individual needs and that the provider had systems in place to protect people from abuse. if concerns had been raised about people's safety the provider had taken appropriate steps to respond to this.

We spoke with staff who told us that they were offered good training and support to enable them to provide good care to people.

We found that people's consent was obtained for their care and treatment at the home. We saw that if someone was unable to consent for themselves, for example due to dementia, that the managers were taking steps to ensure the correct procedures were followed to ensure their rights were protected and decisions made on their behalf were in people's best interests.

We found that people were respected and involved in their care on a daily basis, and also that care planning ensured people's welfare and safety. We saw that staff were knowledgable about how people should be protected from abuse.

We saw that systems meant that the right staff were recruited, and that sufficient numbers were rostered to work on each shift to provide people's care. We found that staff received the right training to deliver care, and that they were well supported by their managers.

Portland Nursing Home had systems in place to monitor the quality of the service and we also saw evidence that their complaints procedure had been used effectively.