Portland Street

Portland Street is a residential care home providing accommodation and personal care for up to 13 people. The service provides support to people with mental health needs. At the time of our inspection there were 10 people using the service but not all of them were in receipt of a regulated activity.

People's experience of using this service and what we found.

Improvements were noted across the whole service and actions were taken to ensure people’s safety and safeguard people from poor care or inappropriate treatment as far as reasonably possible because staff were vigilant and well trained.

Environmental improvements made since the last inspection meant the service provided a homely, well-maintained environment where equipment was regularly checked to ensure people’s continued safety. The environmental risk assessment did not fully address the potential risks from internal and external stairs. We discussed this with the manager about ensuring the risk assessment was fully updated.

Enough staff were employed to ensure people got the support they needed. Staff were friendly and motivated and understood people’s needs well. Staff trusted their manager and felt able to raise any concerns and their views about changes they would like to see.

The registered manager had a good understanding of the mental health system and was a strong advocate for people to ensure they got their needs met. The mental health teams were very complimentary about the staff team and their knowledge of mental health. They said they monitored people well and made referrals at the right time. Communication with external agencies were described as excellent.

Care records gave a good overview of people’s needs and the records were being reviewed to ensure they reflected the person-centred care provided. A range of social opportunities were provided to improve people’s mental and physical health.

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

Medicines were managed safely and missed and refused medicines were brought to the attention of relevant professionals to seek appropriate advice.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Rating at last inspection and update.

The last rating for this service was Inadequate (published October 2022). We found breaches of regulations: for safe care and treatment, consent, staffing, person centred care and good governance. Warning notices were served for all the breaches. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 30/09/2022. During our inspection on the 16/05/2023 the provider demonstrated that improvements had been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures

Why we inspected

We undertook this focused inspection to follow up on the warning notices and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 changed from inadequate to good.

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.

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

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Portland Street is a residential care home providing accommodation and personal care for to up to 13 people. The service provides support to people with mental health support needs. At the time of our inspection there were nine people using the service.

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

People were put at risk of harm due to the lack of safeguarding processes and effective systems in place to implement improvements where risks had been identified. Care plans and risk assessments did not always correlate and identify fundamental information to ensure people were supported in a safe way. People did not always receive their medicines in line with their care plans. There was a lack of staff trained in key areas for their role, which had an impact on delivery of care.

People did not get the support hours they were assessed as needing and this meant people were not always provided with safe support and were unable to experience new things or meet their aspirations.

People were not supported to have maximum choice and control of their lives and staff 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.

The service was not able to demonstrate how they were supporting people in an open and positive culture. People did not receive support that was person-centred and gave them autonomy in their life. Relatives felt there needed to be a stronger focus on people’s interests and ensuring their support was meaningful to them. Support did not focus on people’s quality of life or follow best practice.

Staff told us and records confirmed there needed to be additional training to ensure there was enough appropriately skilled staff to meet people’s needs.

The management team had not always offered the support and leadership required for the staff. The provider and manager had a governance system in place, which included various audits and monitoring, however, these were not effective and did not identify the issues we found.

There had been a recent change in management and immediate improvements had been made and this was recognised by the people living there and the staff.

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 March 2019).

Why we inspected

We received concerns in relation to the management of medicines and people’s support needs. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 changed from good to inadequate based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

Enforcement

We have identified breaches in relation to managing risks, adequately skilled staff, restrictive practice and the lack of quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People’s experience of using this service: People continued to receive care that was safe, effective, caring, responsive to their needs and well-led. People told us they felt safe and were happy living at Portland Street. People were supported to take their medicines in a safe way.

Staff had received appropriate training and support to enable them to carry out their role safely. Peoples health was well managed and staff had positive links with professionals, which promoted well-being for them.

Staff were kind and caring and promoted people’s dignity. Staff understood the importance of treating people with respect and ensured they did this. People were observed to have good relationships with the staff team. Staff actively ensured people maintained links with their friends and family.

People's records clearly identified their preferences. Staff provided effective care for people, which met their needs through person-centred care planning. People enjoyed an extensive programme of activities both in the service and the local community. Complaints were managed within the providers stated process.

Rating at last inspection: Good (Published May 2016)

Why we inspected: This was a scheduled inspection based on our previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Portland Street provides accommodation and personal care for up to eleven adults with mental health needs. On the day of our visit, there were eleven people using the service. The home had a registered manager in place. 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.

There were systems in place to protect people from the risk of abuse. The staff had received appropriate support and training which enabled them to identify the possibility of abuse and take appropriate actions to report and escalate concerns. Risks to people’s safety were assessed and managed appropriately through the use of detailed risk assessments. There were systems in place to monitor the safety of the environment and equipment used within the home minimising risks to people. There were arrangements in place to deal with emergencies. One area of risk that had not been identified was dealt with appropriately during and shortly after our visit.

Robust staff recruitment practices were in place to make sure that the staff were safe to work with the people who lived in the home. There was enough staff on duty to meet the needs of the people living at the home. Medicines were managed, stored and given to people when they needed them by trained and competent staff. There were processes in place to ensure new staff were trained appropriately and staff received regular training, supervision and annual appraisals to enable them to provide people with effective care. Staff gained consent from people before providing them with support .

The registered manager and staff supported people who may not be able to make decisions about their own care in line with relevant legislation .

People were supported to maintain good health and had access to a range of health and social care professionals when required. People's nutritional needs and preferences were met.

Staff knew the people they supported well and provided them with the support they wanted to receive. Staff treated people in a respectful and caring manner and interactions between people and staff were relaxed and friendly. Staff respected people's privacy and dignity. People received care and treatment in accordance with their identified needs and wishes. Care plans documented information about people's personal history, choices and preferences and preferred activities.

People knew how to complain and felt confident to do so if they needed to. People felt that the atmosphere in the home was open, friendly and welcoming and that the registered manager and staff were approachable.There were systems and processes in place to monitor and evaluate the quality of the service provided. Any issues identified by these systems were acted upon quickly and the appropriate actions taken.The service had a positive culture that promoted independence and was responsive to peoples changing needs.

All areas of the service we viewed were visibly clean and orderly. We also saw that people who used the service were encouraged to take a lead role in maintaining the cleanliness of the premises.

We reviewed two staff files that demonstrated appropriate checks were undertaken before new staff began work.

The provider had effective systems in place to regularly assess and monitor the quality of service that people receive.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members. People we spoke with said staff always supported them with their care needs. One person told us that, "they enable independence and provide as safe place to live without fear". They added that they were able to do what they wanted and were supported with their wishes.

Medicines were stored appropriately and records were maintained to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

Improvements had been made to the decor and internal property so that people had a safe and pleasant place to live.

People living at the home and staff members said there were enough staff available to ensure people were cared for properly and received the support they wanted.

People told us that they would be able to make a complaint if they were not happy. The service had a policy and procedure to guide people and visitors in how to make a complaint, although it did not provide correct information about taking complaints further.