Porte Rouge Care Home

Porte Rouge is a residential care home providing personal care to up to 30 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection there were 26 people using the service.

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

Staff had a good understanding of how to keep people safe. People confirmed they felt safe living at Porte Rouge.

Staffing was planned so that people’s needs could be met efficiently. People told us staff responded promptly when they requested help or support.

The manager and senior managers in the organisation had recognised some improvements needed to be made to how medicines were recorded. There was a clear plan in place about how the improvements would be made. People told us staff managed their medicines well and ensured they received them at the right times.

Systems were in place to ensure the service was clean and met good infection control practice. Audits and checks of the environment and equipment helped ensure the service consistently met the correct safety standards.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they were happy and comfortable living at the service, and that they were treated kindly by staff. All staff were focused on helping people achieve good outcomes. A staff member told us they enjoyed being responsive to people’s choices as this helped people have control over their lives.

There was a clear aim to constantly review and improve the service. The nominated individual and manager spoke about plans to empower people to take more control over their lives.

The manager and other senior managers within the organisation had a good understanding of their role and how it fed into the overall quality of the service. Information and updates were regularly shared across all the provider’s services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection The last rating for this service was good (published 10 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good based on the findings of this inspection.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Porte Rouge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

There were clear procedures for visitors to follow regarding testing and wearing PPE (personal protective equipment, such as masks and gloves), before they entered the home. Staff were aware of these and supported visitors to follow them.

People who found it difficult to communicate with staff wearing masks, had been given white boards to aid effective communication.

The service had benefited from learning shared by another home owned by the same provider, that had had a COVID-19 outbreak.

Senior managers carried out regular spot checks and provided updates to staff about wearing PPE. Staff confirmed they received regular updates whenever guidance changed.

We spoke to a person who confirmed staff always wore PPE and that they had felt safe throughout the pandemic.

Porte Rouge is a 'care home'. 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.

Porte Rouge Care Home is registered to provide residential care and accommodation for up to 33 older people who may also be living with dementia. At the time of this inspection, 28 people were living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People received person-centred care which was responsive to their specific needs and wishes. Each person had an up to date, personalised care plan, which set out how their care and support needs should be met by staff. Assessments were regularly undertaken to review people's needs and any changes in the support they required. Any needs in relation to the Equality Act 2010 were specified in care plans and if required, assessments detailed any support people required in relation to the Accessible Information Standard (AIS). The Accessible Information Standard aims to make sure that people who have a sensory loss, disability or impairment get information they can access and understand.

People had access to a wide range of group and individual activities and events they could choose to participate in, for example, baking, cultural awareness events, singing and dancing. These were tailored to meet their specific social needs and interests and enabled people to live an active and fulfilling life. People regularly participated in outings and activities in the local community for example the memory clinic and the local pub. The service also had strong links with local community groups and institutions for example the local primary school and local colleges. People who preferred or needed to stay in their bedroom were also protected from social isolation.

When people were nearing the end of their life, they received compassionate and supportive care. People's end of life wishes were sensitively discussed and recorded.

Staff were aware of people's communication methods and provided them with any support they required to communicate in order to ensure their wishes were identified and they were enabled to make informed decisions and choices about the care and support they received.

The service had appropriate arrangements in place for dealing with people's complaints if they were unhappy with any aspect of the support provided at the home. People and their relatives said they were confident any concerns they might have about the home would be appropriately dealt with by the registered manager and provider.

People were kept safe at the home, cared for by staff that were appropriately recruited and knew how to highlight any potential safeguarding concerns. Risks to people were clearly identified, and ongoing action taken to ensure that risks were managed well.

People's medicines were managed safely and the provider ensured that incidents and accidents were fully investigated. The home was well kept and hygienic.

Staff were well supported through training, supervision and appraisal. Staff worked effectively together to ensure people's needs were communicated and supported them to access healthcare professionals when they needed them. Professional feedback was positive.

People enjoyed the meals available to them and were appropriately supported with eating and drinking. There was a Nutrition “Champion” at the service to support people’s health in this area. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The home was dementia friendly and met the needs of the people living there. A dementia “Champion” kept up to date with best practice. Staff could demonstrate how well they knew people. People and their relatives were very positive about the care provided.

People were treated with privacy and dignity and supported to be as independent as possible whilst any differences or cultural needs were respected.

The service had a robust management structure in place, and quality assurance systems were effective in driving improvements across the home. Feedback about the leadership at the service was very good. The provider and registered manager knew people well. Regular feedback was sought from people and their relatives to ensure they were involved in the development of the service.

Further information is in the detailed findings below.

Porte Rouge Care Home provides residential care without nursing for up to 33 older people. Some people may be living with dementia, or have physical and mental health needs. On the days of our inspection 27 people were living at the care home. Porte Rouge Care Home is on two floors with access to the upper floor via stairs or a passenger lift. All bedrooms have en-suite facilities, and there are also shared bathrooms, shower facilities and toilets. There is one lounge, one dining room, a conservatory, a garden and a patio seating area.

The service had a registered manager. 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 were very complimentary of how the service was managed. The registered manager demonstrated strong leadership and expected high standards. The registered manager was a role model for staff, embedding the provider’s vison and values for high quality and compassionate care. People were at the heart of the service, their views and opinions were respected to enable to the service to develop. There were strong links with the community to help people continue to be part of the local area. The registered manager was passionate about ensuing the service maintained a connection with others.

Effective monitoring systems were in place to help to continually strive for improvement. People knew how to complain and felt confident their concerns would be listened to and people’s complaints were valued and used to improve the service.

The registered manager reflected on her own practice, promoted the ethos of honesty, learned from mistakes and admitted when things had gone wrong. The provider knew how to notify the Care Quality Commission (CQC) of any significant events which had occurred in line with their legal obligations.

People were kept safe and protected from harm. Staff had a good understanding of what action to take if they suspected someone was being abused of mistreated. Risks to people’s care were well managed to help ensure their freedom was supported and respected. Accidents and incidents were monitored to identify themes and to help any reoccurrence. The environment was assessed to help ensure it was safe for people to live in. People’s medicines were managed safely, staff received training and the registered manager took prompt action in response to feedback from external pharmaceutical audits. There were enough staff to meet people’s individual needs, and staffing was adjusted when people’s needs changed. However, some staff told us they were not always able to provide people with the opportunity to go out, because of limited staffing. This was feedback to the registered manager in order for her to address the concerns raised and

to take any necessary action.

People received care from staff who had received training to meet their needs and supervision of their practice. Staffs ongoing career development was encouraged by the registered manager and provider. People’s consent was obtained in respect of care and support and people’s human rights were protected. Staff and the registered manager had a good understanding of the Mental Capacity Act 2005 (MCA) and associated Deprivation of Liberty Safeguards (DoLS). People told us the meals were good. People’s nutrition and hydration was monitored with action being taking when there were concerns identified. People were supported to access health care service to maintain their ongoing health and wellbeing.

People received care and support from staff who were kind and who knew them well. People’s privacy, dignity and independence was promoted by staff who were observant, and personalised in their approach. People views and opinions were sought to help ensure there were involved in decisions about their care. Advocacy services could be accessed when people wished for independent support and advice. People’s needs were met and staff were passionate about recognising people’s differences and finding new ways to support people. The registered manager worked positively with other agencies and used up to date guidance and legislation to help inform staffs practice.

Porte Rouge provides accommodation and personal care for up to 33 people. The home is part of the Torcare group which operates throughout Cornwall. On the day of the inspection visit 26 people were living at the home. The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We gathered evidence against the outcomes we inspected to help answer four of the five key questions. Is the service safe? Is the service caring? Is the service responsive? Is the service well-led?

We gathered information from people who used the service, two visiting healthcare professionals and three visitors by talking with them.

This is a summary of what we found.

Is the service safe?

We found the service was safe. People we spoke with who lived at Porte Rouge told us they felt safe and people confirmed staff were caring and kind.

Staff had received training in safeguarding (recognising and protecting people from abuse) and knew how to report any concerns.

We found the location to be meeting the requirements of the Mental Capacity Act and Deprivation of Liberty Safeguards. This helped to ensure people's rights were respected.

We found the service managed risk well.

Is the service caring?

We found the service was caring. There was a calm and friendly atmosphere within the home and staff helped people maintain their privacy. This showed us people's dignity was protected and respected.

Staff knew the people they were caring for well and communicated with them effectively. This showed us staff were able to respond to people's needs.

Is the service responsive?

We found the service was responsive. Care plans were personalised and reflected people's individual needs. This meant staff knew how people wanted to be supported.

People's individual preferences and choices were identified and respected.

Is the service well led?

The service was well-led. We found there was an open and positive culture within the home. Staff, visiting healthcare professionals, and visitors told us the manager was approachable if they had any concerns or suggestions.

The views of people who lived at the service were actively sought and people told us they felt listened to.

The service had links with other healthcare professionals. This showed they were able to ensure people received appropriate care in a timely manner.

This is a summary of what we found-

Is the service safe?

People we spoke with who lived at Porte Rouge told us they felt safe and people confirmed staff were kind and caring. People who lived at Porte Rouge were cared for in an environment which was safe, clean and hygienic.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DOLs) which applies to care homes. Following our inspection, the nominated individual advised the Commission following changes to the DOLs legislation; they were approaching external professionals as necessary to ensure people were protected in line with the new legislative requirements. This demonstrated the provider was aware of their responsibilities.

Is the service effective?

People we spoke with who lived at the care home were complementary of the care and support they received from staff. Comments included, 'The staff are very good with us', 'I am very lucky to be in this environment; they look after me', 'It is very good; much better than living on my own. I am very comfortable I can't complain' and 'I don't feel like I am in a home; I am home'. We were also told, 'I'd like a little more variety with regards to food', and 'I'd like to see my dentist more'.

Is the service caring?

We observed people who lived at Porte Rouge were supported by kind, caring and compassionate staff who communicated with people in an adult to adult manner. We observed staff to be tactful in their approach, particularly when dealing with sensitive care issues, such as continence.

Is the service responsive?

We saw staff, were responsive to people when they required assistance. We observed people who lived at the care home approach staff fondly to ask for assistance. Care records detailed that people were able to access services out with the care home to ensure their health and wellbeing.

We found, care records and risk assessments were not always reflective of people's care needs. This meant the manager and provider could not demonstrate the care which was being delivered was in line with people's choice, wishes and expectations. A compliance action has been set in relation to recording keeping and the provider must tell us how they plan to improve.

Is the service well-led?

The service had a manager who was registered with the Care Quality Commission. People who lived at Porte Rouge told us they found the manager approachable. People did not have any concerns or complaints, but were confident they could speak with the manager or staff at any time. We found the manager and provider had systems in place to monitor the quality of the service being provided. We found the monitoring and auditing of care records required improvement; however, it was encouraging to find the provider had already identified this through their own quality monitoring processes. Staff we spoke with told us they enjoyed working for the manager and the provider, comments included, ' I'I do enjoy it, itsit's relaxed', 'I can go to her [the manager] anytime', 'helpful, she [the manager] is brilliant' and 'I think all of the managers are so helpful and supportive'.

We were advised that there were 28 people resident in the home. When we visited we saw that Mrs Josephine Whetton was the only registered manager.

People told us they were happy with their care and staff told us they found Porte Rouge Residential Home a place they enjoyed working in.

We found that people were being asked to consent to care and treatment. However, there were concerns that people's care and welfare needs were not being met fully and people could be at risk of inappropriate and unsafe care.

We found that people were having their nutritional needs met and people were offered a range of choices of meals and drinks.

We found that suitable equipment was in use and was maintained regularly to make sure it was safe to use. We did however find that not all electrical equipment was being checked to ensure it was safe and there had not been a recent check against legionnaire disease.

We found there were enough staff to provide care for people and staff were well trained to carry out their role. We found that the system of supervising and appraising staff's training needs was not in place so their on-going competency was not assured.

We found that there was not a robust enough system in place to ensure that the home was monitoring the quality of the service provided.

We found that the home was not letting the Care Quality Commission know of incidents such as people being injured as a result of falling in the home. The home had not taken action to assess and reduce the risks in this area to ensure people were safe and risks were being addressed and reduced as appropriate.

We talked with seven people who lived at the home. They told us 'Staff are really nice, they pop in through the day', 'I am happy and being well looked after' and 'You can't fault it here, it is excellent care'. One person told us 'I would never have thought to look forward to this, but I am enjoying it here'.

We spoke with seven staff who told us that Porte Rouge was a good place to work. They told us that they felt supported in their role and that they had sufficient training in all areas to help them do their jobs well.

We looked at the care provided and records relating to three people. Records relating to people's care were detailed and personal to each person. The details included, enabled staff to meet people's individual needs.

People using the service felt there were sufficient staff on duty to meet their needs. They told us 'when you ring the call bell, they come quickly'. Another person told us 'You don't need to ask, staff just get on and bring you breakfast, coffee and lunch'.

Auditing systems undertaken by the management of the home were in place to monitor the service. These were seen to address any problems found.